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 axillary pressure

The changes in ipsilateral sympathetic tone in response to axillary pressure are well known. However, the response of the nasal mucosa is less well documented. We have attempted to demonstrate this response in normal individuals. Ten individuals with no history of nasal disease or allergy were studied. All subjects were exposed to sustained pressure, using a crutch, for a period of 5 min. Nasal cross-sectional area was measured on both sides of the nose using an acoustic rhinometer along with pulse and blood pressure. The individuals were then rested for at least 30 min and the test repeated with pressure applied to the opposite side. Statistical analysis was performed by non-parametric methods. There was a significant fall in nasal cross-sectional area on the side of pressure (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 were no significant differences between these results and those obtained by axillary pressure on the opposite side. Pulse and diastolic blood pressure rose with axillary pressure while systolic blood pressure remained unaltered. There was no difference in the laterality in the blood pressure response. The results indicate that axillary pressure produces nasal congestion 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 degrees 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.     

Acoustic rhinometry in pre-school children

Acoustic rhinometry was performed in 35 normal nose-breathing children between 3 and 6 years. The average cross-sectional areas at the nasal valve, at the anterior end of the turbinates, and in the nasopharynx were 0.34±0.06 cm², 0.35±0.08 cm² and 1.37±0.48 cm² respectively. The average minimal cross-sectional area was 0.29±0.06 cm². The minimal cross-sectional area was located at the nasal valve in 14 and at the anterior end of nasal tubinates in 21 of the 35 children. As would be expected, the cross-sectional areas at different sites of the nasal cavity increased with increasing age of the children. But, whereas the minimal cross-sectional area increased by 0.024 cm² per year, the nasopharyngeal cross-sectional area increased by 0.20 cm² per year. No significant differences were found between boys and girls. Measurements of the posterior nasal and nasopharyngeal cross-sectional areas were unreliable, whenever the minimal cross-sectional area was less than 0.2 cm². Furthermore, assessment of the nasopharynx may be difficult because of involuntary movements of the soft palate.     

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.     

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.     

Alterations in rhinosinusal homeostasis in a sportive population: our experience with 106 athletes

The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4±4.97 min (normal value: 13±3 min; P<0.0001). The average MCTt for the skier group was 19.58±1.92 min (P<0.0001); the mean value of total basal nasal resistance was 0.37±0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P<0.001). After NDT, total nasal resistance was 0.18±0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64±0.05 Pa/ml per s (P<0.001); the mean cross-sectional area at the nasal valve level was 0.57±0.04 cm² (normal value =0.55±0.05 cm²) and at the inferior turbinate level 0.83±0.05 cm² (normal value =0.4±0.04 cm²; P<0.001); the TMC average time was 27.35±2.21 min (P<0.0001). Finally, for the runners, the mean MCT time was 20.56±2.35 min (P<0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways.     

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.     

Acoustic rhinometry in the evaluation of nasal obstruction

Acoustic rhinometry (AR) is a recently developed objective technique for assessment of geometry of the nasal cavity. The technique is based on the analysis of sound waves reflected from the nasal cavities. It measures cross-sectional areas and nasal volume (NV). To obtain dependable assessments of nasal resistance by rhinomanometry or cross-sectional area measurements by AR, it is essential that the structural relations of the compliant vestibular region remain undisturbed by the measuring apparatus. The use of nozzles in making these measurements carries a great risk of direct distortion of the nasal valve. We used a nasal adapter that does not invade the nasal cavity and a chin support that stabilizes the head. In 51 healthy nasal cavities, the average minimum cross-sectional area (MCA) was 0.62 cm² at 2.35 cm from the nostril and 0.67 cm² at 2 cm from the nostril, respectively, before and after topical decongestion of the nasal mucosa. The MCA and NV findings in this group were significantly higher than MCA and NV (P<0.001) in people with structural or mucosal abnormalities before mucosal decongestion. After mucosal decongestion, the MCA and NV were significantly higher in healthy nasal cavities than in nasal cavities with structural abnormalities (P<0.001) but were not higher than nasal cavities with mucosal abnormalities (MCA, P = 0.05; NV, P = 0.06). A nozzle was applied in 20 healthy nasal cavities after mucosal decongestion, and a significantly higher MCA was found compared to measurements made with the nasal adapter (P = 0.02). We conclude that the nasal adapter, which does not invade the nasal cavities, avoids the distortion of the nasal valve and gives more accurate results.     

鼻声反射和鼻阻力测量在阻塞性睡眠呼吸暂停低通气综合征患者术后鼻功能评估中的应用

目的 探讨鼻声反射和鼻阻力测量在鼻腔扩容手术治疗鼻腔结构异常致阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者鼻功能评估中的应用。方法 选择经多导睡眠监测（PSG）确诊且经视觉模拟量表（VAS）评估具有鼻塞、鼻内镜及鼻窦CT检查证实结构异常的成年OSAHS患者36例作为研究对象。根据检查结果实施个体化的鼻内镜下鼻腔扩容手术。术前及术后6个月所有患者均进行VAS评估、鼻声反射测量和鼻阻力测量,比较手术前后测量结果。结果 患者术前VAS评估计分、鼻腔吸气总阻力、鼻腔呼气总阻力、鼻腔最小横截面积、鼻腔容积、最小横截面积至前鼻孔的距离分别为（6.97±1.27）分、（2.07±1.07）kPa/L·S^-1、（2.15±1.09）kPa/L·S^-1、（0.39±0.16）cm²、（2.20±0.97）cm³及（1.97±0.47）cm;术后6个月分别为（1.33±0.92）分、（1.69±1.03）kPa/L·S^-1、（1.90±1.02）kPa/L·S^-1、（0.51±0.17）cm²、（2.73±1.05）cm³及（2.19±0.46）cm。手术前后各指标差异均具有统计学意义（P均<0.05）。结论 鼻腔扩容术可以显著改善伴有鼻腔结构异常的OSAHS患者的鼻通气功能,鼻声反射和鼻阻力测量能客观评估鼻腔扩容手术治疗前后伴有鼻腔结构异常的OSAHS患者鼻通气功能的变化。     

The effect of nasal mucosal vasoconstriction on nasal airflow sensation

The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. To investigate the relationship between these two parameters 20 healthy volunteers had nasal resistance to airflow measured by rhinomanometry compared with nasal sensation by visual analogue scoring before and after nasal mucosal vasoconstriction using topical 0.1% xylometazoline. The median change in nasal resistance was 0.2 kPal^-1s (95% CI 0.08–0.28 kPal^-1s) and in nasal sensation 24 mm (95% CI 17 mm-35 mm). A significant relationship between nasal sensation and nasal resistance to airflow was found (Kendall's Rank correlation (P < 0.05). This function can be described by the linear regression equation: dS = 13.2 + 70.dNR where dS = change in nasal sensation and dNR = change in nasal resistance. There may be a much closer relationship between subjective and objective measures of nasal patency than has previously been thought.     

Correlation between nasal anatomy and subjective patency: a prospective MRI study

Background: Variations in the thickness of the nasal septum are well documented¹ Objective: To determine if septal mucosal thickness and other parameters derived from MRI imaging correlate significantly with subjective sensation of nasal resistance. Methods: Forty patients undergoing MRI head scans for non-nasal disease were asked to complete a questionnaire immediately prior to the scan being taken. Subjective patency was scored for each nasal airway, patients were also asked about hayfever, URTIs, medication and history of nasal surgery or trauma. Scans were assessed using image analysis software. The following parameters were assessed at the level of the nasal valve: cross-sectional area of airway, horizontal thickness of inferior turbinate and maximum septal mucosal thickness. In addition, the presence of septal deviation (lateral to the vertical plane of the middle turbinate), and sinus mucosal thickening of 4 mm or more was assessed. Repeatability and inter-observer error was calculated. Data was analysed using non-parametric tests and multiple stepwise regression. Results: Overall correlation between anatomical parameters and subjective patency was low. Patients with sinus mucosal thickness greater than 4 mm on MRI scanning had subjectively poorer nasal airways (left P = 0.003, right P = 0.029). Multiple regression confirmed sinus mucosal thickening as the most significant predictor of patency but also negative correlation between ipsilateral mucosal thickness and patency (P < 0.002) and positive correlation between contralateral turbinate thickness (P < 0.01) and patency. Conclusions: Anatomical factors in both ipsilateral and contralateral nasal airways are of importance in subjective nasal patency. Sinus mucosal thickening correlates strongly with subjective nasal obstruction although the mechanism of this relationship is unclear. Non-anatomical and psychological factors are likely to be of considerable importance.     

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).     

The effect of allergen provocation on the nasal cycle estimated by acoustic rhinometry

Conclusion. The overall duration and reciprocity of the nasal cycle were not changed after allergen provocation. The duration of immediate response was 38 min, but the amplitude of the nasal cycle was increased significantly after allergen provocation.

Objective. Nasal airflow is asymmetrical and subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available on how this is affected by allergens. The purpose of this study was to evaluate the effects of allergen provocation on the nasal cycle.

Materials and methods. This study was performed on 25 patients with allergic rhinitis and 25 subjects in a control group with no symptoms of allergic rhinitis. Acoustic rhinometry was used to test patients before and after allergen provocation. The patients underwent acoustic rhinometry at 15-min intervals for evaluation of nasal cycle and 3-min intervals for immediate response.

Results. With the allergic patients, 21 of the 25 patients (84.0%) showed a nasal cycle and they still had a nasal cycle after the allergen provocation. In the study on the changes in the immediate responses, the average recovery time was 38 min and the reduction rate of the non-patent side was higher than that of the patent side. Also, the average period of the nasal cycle was 153 min before the allergen provocation and 140 min on average after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning.     

Changes in nasal mucosal blood flux and air-flow resistance on unilateral histamine challenge

To investigate reflex vascular control in the nose, we challenged each side of the nose with 0.9% saline and histamine (0.3 mg aqueous) and observed changes in unilateral nasal airway resistance (Rnaw) and laser doppler flux (LDF) in response to contra-lateral and ipsilateral challenge in eight normal subjects. Preliminary studies demonstrated that the preferred site for observation of LDF was the nasal septum (same-day concordance 0.920; inferior turbinate 0.307). Ipsilateral contra-lateral saline induced no significant change to either parameter. Ipsilateral histamine produced a highly significant rise in LDF (757 arbitrary units sem 94 at 3 min; baseline 489 sem 75: P < 0.05) and Rnaw (baseline: 3.10, sem 0.52; 5min: 8.81, sem 2.09 cmH₂O/1/s: P < 0.01). Contra-lateral histamine produced a significant P < 0.05) fall in both (LDF 317, sem 24 at 3 min; Rnaw 2.67, sem 0.78 cm H₂O/1/s at 6 min). This previously unrecorded observation suggests a neural reflex that increases the patency of the contralateral nostril after unilateteral obstruction is provoked.     

A validation study of nasal spectroscopy: Rhinolux

This study is the first to validate the Rhinolux against acoustic rhinometry in detecting nasal mucosal swelling when changing body position from sitting to supine. The Rhinolux (Rhios GmbH, Germany) is a new device using a light-absorption technique called nasal spectroscopy and to measure changes in nasal blood volume as a sign of nasal mucosal swelling in real time. The relationship between the changes in nasal blood volume measured with the Rhinolux and changes in nasal mucosal swelling has however, not previously been validated objectively. To evaluate this relationship we compared the Rhinolux to acoustic rhinometry following the change in body position from sitting to supine. The study population consisted of 20 healthy subjects (7 women, 13 men, mean age 34.7 ± 9.3 years). The Rhinolux was applied sitting in the upright position followed by 5 min in the supine position. Acoustic rhinometry was measured sitting in the upright position and after 5 min in the supine position. In seven subjects the measurements were repeated on three different days to assess the repeatability. The mean change from baseline in minimal cross sectional area ΔMCA measured with acoustic rhinometry was −0.12(±0.19) cm² (right + left side), P = 0.013 but ΔE (change in light extinction from baseline) measured with the Rhinolux was unchanged 0.02(±0.18) optical densities (OD), P = 0.56. There was no correlation between ΔE and ΔMCA r = 0.028, P = 0.9. The mean ΔE result from repeated measurements on different days was 0.05(±0.08) OD, P = 0.09 and the ΔMCA was −0.1(±0.11) cm², P = 0.02. This study showed that the changes in nasal blood volume measured with the Rhinolux did not reflect changes in nasal mucosal swelling measured with acoustic rhinometry when changing body position from sitting to supine. The results indicate that the utility of the Rhinolux in assessing nasal mucosal reactions has to be evaluated further.     

Correlation between acoustic rhinometry and visual analogue scale in children with no nasal symptoms: a prospective cohort study

Clin. Otolaryngol. 2011, 36 , 129–133 Objectives: Acoustic rhinometry is an objective tool to evaluate nasal obstruction. The aim of this study was to evaluate the usefulness of visual analogue scale (VAS) as a subjective tool for nasal obstruction and the correlation between acoustic rhinometry and VAS in children with no nasal symptoms. Design: Unilateral acoustic values and VAS were measured at baseline and after decongestion of the nose. Setting: Tertiary academic hospital. Participants: The study included 124 children aged between 7 and 14 years with no permanent nasal symptoms. Results: At baseline, the mean minimal cross‐sectional area on the right side was 0.392 cm² (sd 0.094), and on the left side 0.360 cm² (sd 0.093), whereas the mean VAS on the right side was 7.43 (sd 2.50) and on the left side 6.81 (sd 3.01). After decongestion, the mean minimal cross‐sectional area on the right and left sides were 0.421 cm² (sd 0.087) and 0.373 cm² (sd 0.11), respectively, whereas the mean VAS on the right and left sides were 8.77 (sd 2.02) and 8.54 (sd 2.14), respectively. At baseline, a significant correlation was found between VAS and minimal cross‐sectional area, but no correlation was found between VAS and acoustic values after decongestion. Conclusions: We conclude that VAS shows potential as a subjective tool to investigate nasal obstruction in children over 7 years of age. There was a correlation between VAS and acoustic rhinometry in children with no nasal symptoms at baseline. No correlation was found in children with decongested normal nasal airways.     

Hypoxia Depresses Nitric Oxide Output in the Human Nasal Airways

Objectives The role of oxygen in the nasal air on nasal nitric oxide (NO) output was studied in 13 adult volunteers. Methods Nasal NO was measured while air containing oxygen (0%–100% in nitrogen) was aspirated through the nasal airway before and after the topical application of xylometazoline. Results The mean nasal NO output of the untreated nose was 507.8 ± 161.9 nL/min (mean ± SD) when 21% oxygen was aspirated through the nasal cavities in series and remained unaltered by 100% O₂ (P = .79). Below 10% oxygen the reduction in nasal NO output correlated positively and significantly with the decrease in oxygen concentration (r² = 0.14). NO output was 245.2 ± 153.4 nL/min at 0% oxygen, a significant decline from 21% oxygen (P < .0001). Nasal vasoconstriction induced by xylometazoline and alterations in the blood oxygen content by a maximal breath‐holding or breathing 100% oxygen did not alter nasal NO in hypoxia (P = .41). Conclusions Nasal NO output is markedly depressed in hypoxia and is oxygen dependent at concentrations of less than 10%. Approximately 50% of nasally generated NO is produced from oxygen in nasal air or regulated by it.     

A double-blind randomised controlled trial assessing the efficacy of topical lidocaine in extended flexible endoscopic nasal examinations

Clin. Otolaryngol. 2011, 36 , 550–557 Objective: To test the hypothesis that using lidocaine nasal spray will result in improved pain and comfort outcomes during an extended flexible endoscopic nasal examination. Design: A split‐body, double‐blind, placebo‐controlled randomised trial. After receiving a rinse of oral mouthwash (Listerine^®), patients were randomised to receive placebo in one nasal cavity and 30 mg of topical lidocaine in the other. Setting: A tertiary care centre outpatient Otolaryngology clinic. Participants: Twenty‐two patients who required an extended bilateral flexible endoscopic nasal examination. An extended nasal examination consisted of an examination of a minimum of two osteomeatal regions on each side of the nasal cavity. Main outcome measures: Discomfort and pain were assessed using a 100‐mm Visual Analogue Scale (VAS). Our study utilised the definition of pain based on International Association for the Study of Pain. Pain was defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Discomfort was defined as the overall unpleasant experience of the procedure. This included all aspects of the examination such as the pain or other negative sensations associated with the examination, any side effects associated with the application of the nasal sprays as well as any anxiety associated with the examination. A Wilcoxon sign‐rank test was used for the primary outcome measures. Results: There was a significant reduction in discomfort scores on the treatment side of the nasal cavity compared with the control side (median VAS score of 18.6 mm versus 44.6 mm; P = 0.01). The change in pain between the treatment side compared with the control side did not reach our definition of statistical significance (5.1 mm versus 9.2 mm; P = 0.05). Patients with an active or uncontrolled inflammatory disorder of the nasal cavity experienced a significantly greater reduction in pain compared to those without an inflammatory condition (median change of the VAS score, ?15.6 versus +1.0; P = 0.01). Conclusions: After a rinse with oral mouthwash, the use of lidocaine results in a significant reduction in the discomfort associated with an extended bilateral flexible endoscopic nasal examination. Patients undergoing such an examination would benefit from the application of lidocaine after masking the negative flavour using oral mouthwash.     

Mastoid pneumatization and aging in children with Pierre-Robin syndrome and in the cleft palate population out of syndrome

We examined the characteristics of mastoid pneumatization in the Pierre-Robin syndrome (PRS) and non-PRS cleft palate population in relation to age. There were 14 patients with PRS (median age, 5 years), 7 patients with bilateral cleft lip-palates (BCLP: median age, 6 years), 29 patients with unilateral cleft lip-palates (UCLP: median age, 6 years) and 15 patients with isolated cleft palates (ICP: median age, 7 years). All had secretory otitis and ventilation tubes inserted. Pneumatization was assessed by standard computerized planimetric methods. Temporal bone (Schüller view) X-rays were obtained. Areas of bone pneumatization were outlined and measured separately for each ear. The median pneumatized area of the mastoid (MBP) in PRS patients (6.73 cm²) was significantly lower than in non-PRS cleft patients (7.29 cm²). It was also lower than in UCLP (7.35 cm²; P = 0.01) and ICP (7.19 cm²; P = 0.02). MBP did not change significantly with age in PRS (Spearman r _s = 0.11) and BCLP (Spearman r _s = 0.11), but did increase significantly in the ICP group (Spearman r _s = 0.23; P = 0.04). Cubic regression showed the best fit in the BCLP (r ² = 0.61; P = 0.01) and ICP (r ² = 0.10; P = 0.05). It was not significant for PRS (r ² = 0.132) or UCLP (r ² = 0.049). We concluded that pneumatization in all cases increases with age, but it is statistically significant only in ICP. PRS patients have a lower area of mastoid air-cell size than the non-PRS cleft palate population. The extent of mastoid pneumatization in PRS patients does not correlate with age because of the negative influence of the mandibular hypoplasia and glossoptosis present. Received: 30 July 1998 / Accepted: 1 October 1998