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.     

Temperature and humidity profile of the anterior nasal airways of patients with nasal septal perforation

INTRODUCTION: The most frequent symptoms of patients with nasal septal perforations are crusting and bleeding. The aim of this study was to determine the influence of septal perforations on temperature and humidity of the anterior nasal airways. PATIENTS AND METHODS: Intranasal temperature and humidity were measured in the nasal valve area, the anterior turbinate area and in the nasopharynx during normal respiration. A miniaturized thermocouple and a humidity sensor were used for continuous detection. Ten patients with septal perforations were enclosed into the study. The results were compared to matched healthy control subjects. RESULTS: There were no significant differences of the temperature and humidity values between the left and right side of the nasal cavity in each study group. At the end of inspiration, nasal air temperature did not differ significantly between the two study groups. The humidity values at the end of inspiration were statistically significantly lower in the patient group. CONCLUSIONS: Nasal septal perforations seem to be related to lower humidity in the anterior nasal airways during inspiration. Reduced humidity may contribute to crusting as a main symptom.     

The effect of topical xylometazoline on the mucosal temperature of the nasal septum

BACKGROUND: The purpose of this study was to determine the short-term influence of the alpha2-adrenoreceptor agonist xylometazoline on the nasal mucosal temperature. METHODS: Thirty healthy subjects were enrolled into the study. Fifteen of these subjects got xylometazoline and 15 subjects, matched to age, got saline solution as control. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature without interruption of nasal breathing before and after application of nose spray. RESULTS: In the anterior nasal segment, the mucosal temperatures before decongestion were significantly higher than after decongestion (p < 0.05). These changes could not be found in the control group after saline solution. The mean end-expiratory mucosal temperatures were significantly higher than the end-inspiratory ones in both study groups (p < 0.005). CONCLUSIONS: The reduction of the nasal mucosal bloodflow because of vasoconstriction and the increase of the nasal cavity volume after decongestion with xylometazoline seem to cause a significant decrease of the septal mucosal temperature in the anterior nasal segment. This might be one possible causative factor of the common symptom of the "dry nose" in patients with nasal decongestant abuse.     

Temperature profile in the nasal cavity

OBJECTIVES/HYPOTHESIS: Inspired air is heated and moistened as it passes the nasal cavity. The temperature increase should be similar to a heated tube model, depending on the airflow. STUDY DESIGN: Intranasal temperature values of 50 volunteers were measured after inspiration at different locations: nasal vestibule, nasal valve area, anterior to the head of the middle turbinate, and the nasopharynx. Temperature values were related to nasal airway resistance data. METHODS: Intranasal temperature measurements were made with a miniaturized thermocouple. Nasal airway resistance was detected by active anterior rhinomanometry. RESULTS: A logarithmic increase of air temperature from the anterior segment of the nose to the posterior part was noted. In the nasopharynx temperature was approximately 34 degrees C. The highest increase in temperature was observed in the nasal valve area. CONCLUSIONS: The temperature increase of ambient air in the nasal airways can be compared with a logarithmic curve of the heating of air passing a heated tube. As the heating of air is important for water transport, the space between the nasal valve and the middle turbinate is of special functional importance. No correlation to the results of rhinomanometry was found.     

Erwärmung der Atemluft in der Nase

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine whether the temperature at the end of inspiration is the same as the temperature a few seconds after breathing stops at the end of inspiration to study if the nasal mucosa are capable of providing heat during a cessation of breathing. PATIENTS/METHODS: Fifteen healthy volunteers were included in the study.The temperature at the end of inspiration was compared to the temperature obtained 5 s after cessation of breathing at the end of inspiration and at the end of expiration. Intranasal temperature measurements were taken at three locations in the nose with a miniaturized thermocouple. RESULTS: The temperature increased during cessation of breathing at all locations.The highest temperature differences between the end of inspiration and 5 s later (breathing at rest) could be observed at the nasal valve area.The lowest temperature difference was found in the nasopharynx. At the end of expiration,the temperature decreased only slightly from the nasopharynx to the nasal valve area. CONCLUSIONS: The anterior part of the nose in particular is capable of heating the inspired air.This is also important for humidification. Heating of inspired air requires special anatomical conditions of the anterior nasal segment.     

Immediate effect of benzalkonium chloride in decongestant nasal spray on the human nasal mucosal temperature

Benzalkonium chloride is a preservative commonly used in nasal decongestant sprays. It has been suggested that benzalkonium chloride may be harmful to the nasal mucosa. Decongestion with the vasoconstrictor xylometazoline containing benzalkonium chloride has been shown to cause a significant reduction of the nasal mucosal temperature. The purpose of the present study was to determine the short-term influence of xylometazoline nasal spray with and without benzalkonium chloride on the nasal mucosal temperature. Healthy volunteers (30) were included in the study. Fifteen volunteers received xylometazoline nasal spray (1.0 mg/mL) containing benzalkonium chloride (0.1 mg/mL) and 15 age-matched subjects, received xylometazoline nasal spray without benzalkonium chloride. Using a miniaturized thermocouple the septal mucosal temperature was continuously measured at defined intranasal detection sites before and after application of the nasal spray. The mucosal temperature values did not significantly differ between the group receiving xylometazoline containing benzalkonium chloride and the group receiving xylometazoline spray without benzalkonium chloride before and after decongestion (P > 0.05). In both study groups septal mucosal temperatures significantly decreased after decongestion (P < 0.05) because of a reduction of the nasal mucosal blood flow following vasoconstriction. This study indicates that benzalkonium chloride itself does not seem to influence nasal blood flow and nasal mucosal temperature in topical nasal decongestants.     

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.     

Manometric rhinometry

A new method of measuring nasal volume is described. It works by extracting air from a closed cavity and measuring the resultant pressure change. To validate this method in the nose, 17 healthy volunteers were examined before and after application of xylometazoline. The apparent volume before decongestion was a mean of 204 ml. After decongestion the average volume was 228 ml. The difference is highly significant (P < 0.01). We conclude that manometric rhinometry is a valid method of investigating the nose and sinuses.     

Impact of unilateral sinus surgery with resection of the turbinates by means of midfacial degloving on nasal air conditioning

OBJECTIVE/HYPOTHESIS: One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air. STUDY DESIGN: Retrospective study. METHODS: Humidity and temperature were measured in the nasopharynx during normal respiration by means of a miniaturized thermocouple device and a humidity sensor for continuous detection. Eight patients after prior unilateral sinus surgery by means of midfacial degloving for a one-sided inverted papilloma were enrolled into the study. The humidity and temperature data of the surgically treated side were compared to the values of the healthy side that was not surgically treated. Active anterior rhinomanometry and acoustic rhinometry were performed. RESULTS: At the end of inspiration, absolute humidity and temperature values in the nasopharynx were statistically significantly lower on the surgically treated side compared with the side that was not surgically treated. CONCLUSIONS: Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity. Reduced absolute humidity and temperature may contribute to crusting, bleeding, and nasal dryness as frequent complaints of patients after aggressive sinus surgery with resection of the turbinates.     

Heating of air in the nasal airways in patients with chronic sinus disease before and after sinus surgery

The main goal of this study was to determine the influence of sinus surgery on the heating of inspired air in the nose. Intranasal temperature values of 22 patients with chronic sinus disease were measured after inspiration at different locations in the nasal cavity. Measurements were done before and 6-8 weeks after sinus surgery. The patients were compared to 22 healthy control subjects. Nasal airway temperature did not differ between the two study groups at any location in the nasal cavity. Nasal decongestion was without significant influence on temperature values in the patients and the volunteers. There was no significant difference of nasal airway temperature before and after sinus surgery. Even after sinus surgery the main area of heating of inspired air seemed to be the anterior part of the nose. Sinus surgery in patients with chronic sinus disease does not seem to influence heating of air in the nasal cavity.     

Nasal mucosal temperature during respiration

One of the most important functions of the nose is heating the inspiratory air. The aim of the present study was to measure nasal mucosal temperature at defined intranasal sites during respiration, without interruption of nasal breathing. A total of 15 healthy volunteers was included in the study. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature in the nasal vestibule, the nasal valve area, the anterior turbinate area and the nasopharynx during respiration. The highest temperature values were measured at the end of expiration, the lowest values at the end of inspiration with a statistically significant difference (P < 0.005). Mean mucosal temperature ranged from 30.2 +/- 1.7 degrees C to 34.4 +/- 1.1 degrees C. Statistically there were significant differences between the detection sites during inspiration and expiration (P < 0.05). In our study, the temperature values of the nasal mucosa depend on the intranasal detection site and the respiratory cycle. We therefore conclude that whenever data of nasal mucosal temperature are published, it is absolutely essential to describe the precise site of detection and to give information about the time of detection in the respiratory cycle.     

Nasal mucosal temperature after exposure to cold, dry air and hot, humid air

OBJECTIVE: To determine the influence of variations in the temperature and humidity of inhaled air on the nasal mucosal temperature at various sites in the nasal airways. MATERIAL AND METHODS: Fifteen volunteers were enrolled in the study. The temperature was measured on the mucosal surface of the nasal septum at the level of the nasal vestibule, in the nasal valve area, anterior turbinate area and choanae. Temperature measurements were made using a miniaturized thermocouple. Continuous temperature readings were performed before and after 10 min of exposure to either cold, dry air, ambient air or hot, humid air. RESULTS: Inhalation of cold, dry air significantly reduced the temperature of the septal mucosa at each location of measurement compared to the breathing of ambient air. Inhalation of hot, humid air significantly increased the septal mucosal temperature at all detection sites CONCLUSIONS: The climatic condition of inhaled air can lead to significant changes in nasal mucosal temperature. As the nasal mucosa is important for nasal air conditioning, short-term exposure to air of extreme temperature and humidity can rapidly compromise nasal air conditioning.     

Intranasal temperature and humidity profile in patients with nasal septal perforation before and after surgical closure

Common complaints of patients with a nasal septal perforation are crusting, dryness and bleeding. As shown previously, intranasal humidity values are significantly lower in patients with a septal perforation compared with healthy volunteers. The aim of this study was to determine the influence of surgical closure of septal perforations on intranasal temperature and humidity, and to evaluate changes in clinical symptoms after surgery. Ten patients with septal perforations were included in the study. Intranasal temperature and humidity were measured at the nasal valve and anterior turbinate areas before and after surgical closure. Clinical symptoms were assessed using a nasal symptom score. The end‐inspiratory humidity values were significantly (P ≤ 0.05) higher postoperatively than preoperatively. The increase in temperature at the anterior turbinate area was significantly higher postoperatively. The temperature values at the nasal valve area were not significantly different. Recurrent epistaxis and nasal dryness were reduced after surgery. Nasal septal perforations disturb the intranasal temperature and humidity profile. After surgical closure, heating and humidification is improved. This may be responsible for the reduction of frequent complaints such as bleeding and dryness.     

Acoustic rhinometry: values from adults with subjective normal nasal patency.

The nose with normal feeling of nasal patency, and no gross structural changes has been described in 82 individuals by acoustic rhinometry. Curves for one and both sides of the nasal cavity and before and after decongestion have been recorded. We have found that the minimal cross-sectional area (MCA) is located anteriorly in the nasal cavity; in some subjects it is localized at the head of the inferior turbinate and in other subjects more anteriorly at the nasal valve. After decongestion MCA moves even more anteriorly. Beyond the MCA the dimension of the nasal cavity increases, with maximal effect of decongestion at 4 cm from nostrils. Decongestion increases the total volume of the nasal cavity by 35%.     

Simultaneous in vivo measurements of intranasal air and mucosal temperature

Nasal cavity volume and blood temperature along the nasal airways, reflecting the mucosal temperature, are considered to be the most important predictors of nasal air conditioning. The purpose of this study was to simultaneously in vivo measure intranasal air as well as mucosal temperature for the first time. Fifteen healthy subjects were enrolled into the study. Two combined miniaturized thermocouples were used for simultaneous recording of intranasal air and mucosal temperature within the anterior turbinate area close to the head of the middle turbinate without interruption of nasal breathing. The highest air and mucosal temperature values were detected at the end of expiration, the lowest values at the end of inspiration. The difference was statistically significant (P < 0.05). The mean mucosal temperature ranged from 30.2 ± 0.9 to 32.2 ± 0.8°C. The mean air temperature ranged from 28.5 ± 1.2 to 34.1 ± 0.7°C. The mean differences between air and mucosal temperature were 1.7 ± 0.5°C after inspiration and 1.9 ± 0.7°C after expiration. Simultaneous measurements of intranasal air and mucosal temperature are practicable. The detected temperature gradient between air and mucosa confirm a relevant heat exchange during inspiration and expiration. This gradient between air and mucosa is obligatory for heat and water exchange to ensure adequate nasal air conditioning.     

Effects of the Cottle's maneuver on the nasal valve as assessed by acoustic rhinometry

BACKGROUND: The nasal valve is the narrowest segment of the nasal cavity and plays an essential role in breathing. There has been plenty of discussion in the literature concerning the location and function of the nasal valve. The Cottle's maneuver (CM) is a test in which the cheek on the side to be evaluated is gently pulled laterally with one to two fingers to open the valve. This test is used to determine if the most significant site of nasal obstruction is at the valve or farther inside the nasal cavity. The aim of this study was to determine the dimensional changes caused by the CM in the nose as measured by acoustic rhinometry (AR). METHODS: Eight adult volunteers with no nasal symptoms were recruited and their nasal cavities were measured by AR. The measurements were done with and without the CM both before and after decongestion with a mixture of 1:1000 epinephrine and 4% lidocaine in cotton pledgets. The MCA1 and MCA2 and their distances from the nostril, as well as the volume-measured from the zero point to the MCA2 point--were determined. RESULTS: The main effect of the CM was a mean increase in MCA1 by 33% (p = 0.001) and 44% (p < 0.001) before and after decongestion, respectively. The distance of MCA1 increased significantly, because of the CM, by 12% (p = 0.006) before and 7% (p = 0.008) after decongestion. The percentage increases in volume were 33% (p = 0.001) and 44% (p < 0.001), respectively. Decongestion of the nasal mucosa induced a statistically significant (p = 0.001) increase in both MCA1 (by 21%) and MCA2 (by 28%). CONCLUSION: The CM significantly increased MCA1 in AR, and the increase was more evident after decongestion of the nasal mucosa. The changes in MCA2 were nonsignificant. We conclude that the value of the CM in investigating a possible valve insufficiency may be greater if the nose is studied both before and after decongestion of the nasal mucosa.     

Nasal air conditioning in patients before and after septoplasty with bilateral turbinoplasty

OBJECTIVE: Septoplasty is one of the most frequently performed surgical procedures by ear, nose, and throat surgeons. Yet the objective control of success concerning septal surgery still is very difficult and causes controversy. Data concerning one of the main functions of the nose, namely the heating and humidification of inspired air, before and after nasal surgery, are still missing. Therefore, the aim of this study was to compare intranasal air temperature and humidity values before and after septoplasty with bilateral turbinoplasty. METHODS: Sixteen patients were included in this prospective study. Intranasal temperature and humidity were measured in the anterior turbinate area close to the head of the middle turbinate. A miniaturized thermocouple and a humidity sensor were applied for continuous intranasal detection. RESULTS: Significant differences between temperature and humidity values before and after septoplasty could be observed, including absolute temperature, increase in temperature, absolute humidity, and increase in humidity. The postoperative values were significantly higher than the preoperative ones (P < .05). CONCLUSIONS: According to the results of our study, patients seem to profit from septoplasty as heating and humidification as one of the most important nasal functions are restored and even improved after surgery. We therefore conclude that properly performed septoplasty is able to main its importance within the variety of nasal surgical procedures ensuring improved nasal function as well as patient contentment.     

Nasal Mucosal Temperature after Exposure to Cold,Dry Air and Hot,Humid Air

Objective - To determine the influence of variations in the temperature and humidity of inhaled air on the nasal mucosal temperature at various sites int he nasal airways.

Materials and Methods - Fifteen volunteers were enrolled int he study. The temperature was measured on the mucosal surface of the nasal septum at the level of the nasal vestibule, in the nasal valve area, anterior turbinate area and choanae. Temperature measurements were made using a miniaturized thermocouple. Continuous temperature readings were performed before and after 10 min of exposure to either cold, dry air, ambient air or hot, humid air.

Results - Inhilation of cold, dry air significantly reduced the temperatyre of the septal mucosa at each location of measurement compared to the breathing of ambient air. Inhalation of hot, humid air significantly increased the septal mucosal temperature at all detection sites.

Conclusions - The climatic condition of inhaled air can lead to significant changes in nasal mucosal temperature. As the nasal mucosa is important for nasal air conditioning, short term exposure to air of extreme temperature and humidity can rapidly compromise nasal air conditioning.     

Use of pharmacologic decongestion in the generation of rhinomanometric norms for the nasal airway

It has been reported that nasal decongestion can be more effectively achieved by regulated exercise than by the use of decongestant nose drops. To test this finding, we assessed the relative effectiveness of physical exercise, nose drops, and sprays on 100 consecutive patients with nasal congestion. We found that decongestion was best achieved by spraying the nasal mucosa twice, seven to eight minutes apart, with 0.1% xylometazoline solution (Otrivin; Ciba-Geigy). This study demonstrates that rhinomanometric improvement correlates well with subjective improvement following septoplasty. Rhinomanometric limits for the selection of patients suitable for functional operations of the septum or lateral walls of the nose are presented.     

Endonasales Temperatur- und Feuchteprofil nach Exposition zu verschieden klimatisierter Einatemluft

Background and objective. The nose as the first segment of the upper respiratory tract is exposed to different climatic conditions of the ambient air. The purpose of this study was to determine whether nasal air conditioning of ambient air is influenced by a short-term exposure to air of different climatic conditions. Patients and Methods. Fifteen healthy volunteers were enclosed into the study. A miniaturised humidity sensor and thermocouple was used for detection of humidity and airway temperature at three detection sites within the anterior nasal cavity. Both parameters were measured at the end of inspiration during breathing of ambient air after exposure to cold dry air, “normal” ambient air, and warm humid air for 10 minutes. Results. The end-inspiratory intranasal humidity during breathing of ambient air increased at all locations within the nose when the temperature and humidity of the exposure condition increased. At the most anterior detection site, the effect of increase in humidity after exposure to the different climatic conditions was the most pronounced. The increase in intranasal temperature had no relation to the different climatic conditions during the short-term exposure. Conclusions. The results suggest that nasal humidification in ambient air can be influenced by short-term exposure to air of extreme temperature and humidity prior to breathing of ambient air.