Advances in etiology and mechanism of structural nasal obstruction / 临床耳鼻咽喉头颈外科杂志

Summary: Structural nasal obstruction（SNO） is a series of diseases caused by congenital or acquired structural anatomical abnormalities of nasal airway and its surrounding tissues, which leads to increased nasal ventilation resistance. The effect of medication drugs for SNO is poor and surgical intervention is often needed. However, the abnormal structure of nasal airway is very complex, including the periphery of nasal airway, internal nasal airway, the front and rear of nasal airway and complex factors. These abnormal structures may interfere with the nasal airflow mechanics by changing the nasal ventilation volume and disrupting the symmetry of the bilateral nasal cavity, and finally lead to subjective feeling of nasal obstruction. In addition, the structure of nasal airway has plasticity. After the abnormal structure appears, the corresponding compensation of nasal airway can occur to ensure normal nasal ventilation and bilateral nasal cavity symmetry. Therefore, the SNO is the result of the failure of nasal airway remodeling after the appearance of abnormal structures. The etiology of SNO is complex, involving original structural abnormalities, nasal symmetry changing and nasal airway structure remodeling. Therefore, accurate identification of the main factors leading to SNO is the vitalpremise of making personalized nasal ventilation surgery.

An often neglected area in crooked nose: middle turbinate pneumatization / Uma área frequentemente negligenciada no nariz torto: pneumatização da concha média

Abstract Introduction: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective: To investigate the association between crooked nose and the presence of a BMT. Methods: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion: This study revealed a link between crooked nose and BMT.

Resumo Introdução: O nariz torto ou o nariz com desvio é um nariz com um desvio da posição vertical reta da face. A pneumatização extensa da concha média, também chamada de concha bolhosa ou concha média bolhosa (CMB), é conhecida por ser um dos possíveis fatores etiológicos da obstrução nasal, sinusite recorrente e cefaleia. Não há estudo relativo a uma associação entre CMB e nariz torto. Objetivo: Investigar a associação entre o nariz torto e a presença de CMB. Método: Foram analisados retrospectivamente 199 pacientes que se submeteram a septorrinoplastia aberta. Achados pré-operatórios paranasais à tomografia computadorizada (TC), fotodocumentação pré-operatória e exame rinoscópico anterior foram registrados. Dos 199 pacientes, observou-se que 169 atendiam aos critérios e foram incluídos no estudo. As TC foram examinadas para observar a presença de CMB, hipertrofia de conchas inferiores e desvio de septo (DS). Os DS e narizes tortos foram então classificados. Resultados: Dos 169 pacientes, 94 (56%) apresentavam uma deformidade de nariz e 75 (44%) apresentavam nariz reto. Enquanto 49 (52%) pacientes com nariz torto tinham CMB extensa, 20 pacientes com nariz reto (26,6%) tinham CMB. Uma relação estatisticamente significativa foi encontrada entre a presença de nariz torto e CMB, independentemente do lado da doença (p = 0,011). Conclusão: Este estudo revelou uma relação entre o nariz torto e CMB.

Does a correlation exist between nasal airway volume and craniofacial morphology: A cone beam computed tomography study.

Aim: To find the correlation between nasal airway volume and the craniofacial morphology using cone beam computed tomography (CBCT). Materials and Methods: This study consisted of preorthodontic anonymized CBCT scans of 34 healthy adults in the age span of 18–28 years. The volume was calculated using Dolphin 3DR software 11.5 version using semiautomatic segmentation method to calculate nasal volume after determining the nasal airway boundary. The subjects were grouped according to sagittal skeletal relation, craniofacial width, facial index, and facial form. Results: There was statistically significant correlation between nasal volume and craniofacial width (P = 0.009). Conclusion: Nasal volume was correlated only with width of the face and not with width/length ratio of face that could have affected the nasal volume.

Effects of Hot Spring Bathing on Nasal Obstruction —Investigation using rhinomanometry— / 日本温泉気候物理医学会雑誌

<B>Background:</B> Nasal obstruction is an annoying condition. In this study, we evaluated the effects of hot spring bathing at 41 to 42°C using a rhinomanometer.<br><B>Methods:</B> Ten healthy adult volunteers (10 men, mean age of 27.8±4.4 years) were asked to bathe in a hot spring for 10 minutes. Using a rhinomanometer (HI-801), nasal resistance was measured before and after bathing by active anterior rhinomanometry. Total nasal resistance was calculated using Ohm’s law formula with right and left nasal resistance values (1/T=1/R+1/L, T: bilateral resistance, R: right resistance, L: left resistance). Resistance at ΔP=100 Pa was used for evaluation.<br><B>Results:</B> Right and left nasal resistance values were significantly decreased after bathing in subjects with a pre-bathing nasal resistance of greater than 0.75 Pa/cm<SUP>3</SUP>/s (inspiratory, <I>P</I>=0.0117; expiratory, <I>P</I>=0.0277; Wilcoxon <I>t</I>-test). No significant change was observed in subjects with a pre-bathing nasal resistance of below 0.75 Pa/cm<SUP>3</SUP>/s.Post-bathing total nasal resistance was significantly decreased in subjects with a pre-bathing nasal resistance of greater than 0.5 Pa/cm<SUP>3</SUP>/s (<I>P</I>=0.0115; Wilcoxon <I>t</I>-test).<br><B>Conclusion:</B> This study showed that nasal obstruction can be improved by hot spring bathing, which may contribute to the reasons why cold symptoms are relieved by hot spring bathing.

Effects of Hot Spring Bathing on Nasal Obstruction —Investigation using rhinomanometry— / 日本温泉気候物理医学会雑誌

Background: Nasal obstruction is an annoying condition. In this study, we evaluated the effects of hot spring bathing at 41 to 42°C using a rhinomanometer. Methods: Ten healthy adult volunteers (10 men, mean age of 27.8±4.4 years) were asked to bathe in a hot spring for 10 minutes. Using a rhinomanometer (HI-801), nasal resistance was measured before and after bathing by active anterior rhinomanometry. Total nasal resistance was calculated using Ohm’s law formula with right and left nasal resistance values (1/T=1/R+1/L, T: bilateral resistance, R: right resistance, L: left resistance). Resistance at ΔP=100 Pa was used for evaluation. Results: Right and left nasal resistance values were significantly decreased after bathing in subjects with a pre-bathing nasal resistance of greater than 0.75 Pa/cm3/s (inspiratory, P=0.0117; expiratory, P=0.0277; Wilcoxon t-test). No significant change was observed in subjects with a pre-bathing nasal resistance of below 0.75 Pa/cm3/s.Post-bathing total nasal resistance was significantly decreased in subjects with a pre-bathing nasal resistance of greater than 0.5 Pa/cm3/s (P=0.0115; Wilcoxon t-test). Conclusion: This study showed that nasal obstruction can be improved by hot spring bathing, which may contribute to the reasons why cold symptoms are relieved by hot spring bathing.

Numerical simulation for the influence of nasal cavity structure on nasal function of warming and humidifying the inhaled airflow / 医用生物力学

Objective To study the influence of nasal cavity structure on nasal function of warming and humidifying the inhaled airflow. Method Nine normal persons and two patients with deviation of nasal septum (pre and post operation) were selected as research subjects. The three dimensional finite element model of nasal cavities of these volunteers was established. Numerical simulations for the airflow distribution, the airflow temperature and the airflow humidity in the nasal cavity were performed. Based on the simulation results, comparisons were made between normal nasal cavities and the patient’s nasal cavities as well as between the pre-and post-operative nasal cavities. ResultsIn the wider side of nasal cavity, the volume flow rate and the velocity of airflow were higher and the effect of warming and humidifying on the airflow was worse. For normal people, the nasal cavity for warming and humidifying the inhaled airflow was in the anterior segment of the nose. While for the patients, the main segment of warming and humidifying the inhaled airflow had to depend on the airway geometry. Conclusions The nasal cavity structure can influence the effect of warming and humidifying on the airflow. The parameters describing the geometry of nasal cavity, such as the surface area of nasal airway and volume of nasal cavity, may be a useful measurement for the nasal function of warming and humidifying the inhaled airflow.

The Effects of Adenoidectomy on Nasal Airway Resistance and Nasal Geometry

The primary objective of this study was to determine whether adenoid hypertrophy and subsequent adenoidectomy affect pediatric nasal airway resistance and nasal geometry. The secondary objective was to evaluate the relationships between the degree of adenoid hypertrophy and nasal airway resistance or nasal geometry. Fifty-one children, aged 5 to 10 years, selected for adenoidectomy due to chronic nasal obstruction and mouth breathing were enrolled. The size of adenoid was evaluated by cephalometric radiograph. Nasal airway resistance and nasal geometry were evaluated by active anterior rhinomanometry and acoustic rhinometry respectively. These measurements were repeated 3 months after operation. The size of adenoid was found well correlated to preoperative nasal airway resistance but was not to preoperative nasal geometry. Nasal geometry was not changed after operation. However, nasal airway resistance was reduced significantly at 3 months after operation and the size of adenoid was found well correlated to postoperative changes of nasal airway resistances.

A Study of Nasal Airway Resistance and Nasal Airflow in Augmentation Rhinoplasty

Active anterior rhinomanometry (AAR) was performed in 42 patients with low-profile or saddle noses before augmentation rhinoplasty (AR) and after AR. The purpose was to measure nasal airway resistance (NAR) and nasal airflow (NAF). There were 38 females and 4 males, whose ages ranged from 15 to 42 years (mean 29.6 years). Preoperative total NAR at 75 Pascals (Pa) was 0.24+/-0.09 and 0.20+/-0.06 Pa/ml/sec for the non-decongested and decongested value respectively. Two weeks postoperatively, the total NAR was 0.19+/-0.06 and 0.15+/-0.05 Pa/ml/sec for the non-decongested and decongested value respectively, which was significantly less than the preoperative value. The postoperative total NAF was 422.31+/-137.05 cm3 and 514. 57+/-152.45 cm3 for the non-decongested and decongested value respectively, which was significantly increased when compared to the preoperative value (342.57+/-109.27 cm3 and 399.90+/-106.98 cm3 for the non-decongested and decongested value respectively). The comparison between the changes in NAR and subjective nasal breathing showed that the postoperative NAR decreased in 88.10% of patients while subjective nasal breathing improved in only 52.38%. Postoperative NAR increased in 9.52% of patients, while subjective nasal breathing was worsened in 2.38%. The results of this study indicate that AR has decreased the NAR and increased NAF, and thus improving the nasal breathing. From this preliminary study it is concluded that AR is useful not only for the aesthetic aspect but also for its effect on the function of the nose, especially on the improvement of nasal breathing.

Nasal airway resistance in asymptomatic Thai population.

Active anterior rhinomanometry was performed for the first time on one hundred and forty-six Thai adults without nasal symptoms. The subjects were divided into two groups : group I – with normal rhinoscopic appearance and Group II – with slight septal deformity. Transnasal airflow and nasal airway resistance (NAR) were measured by ATMOS Rhinomanometer 220 in each subject before and after decongestion. The statistical analysis showed that the nasal airflow and ANR in both groups were not significantly different. The normal NAR at a differential pressure of 75 Pascals in Thai adults was 0.22 + 0.10 Pa/cc/sec before decongestion and 0.16 + 0.06 Pa/cc/sec after decongestion. This value is slightly lower than the average NAR reported in Caucasian and in Negroid Nigerians. We also found that NAR in female subjects was significantly higher than in males. There was no correlation between NAR and age and weight, but a statistically significant inverse correlation with the height of the subject was observed.