Changes in the cross-sections of the nasal cavity assessed by acoustic rhinometry in the study population as a guideline for attempts to standardize nasal provocation tests.

Introduction: A specific difficulty in the standardization of nasal allergen challenge tests as measured by acoustic rhinometry is the lack of reference values measured according to dependent changes, for example height and weight/height- or weight-dependent changes. Human growth and development rates and other changes the human body undergoes throughout the lifetime depend closely on the environment, sex, and race. Aim: To assess selected anthropometric (body weight and height) and rhinometric (nasal cross-sectional areas) measurements concerning subject age and sex. Material and methods: The study was conducted in 633 subjects selected in multistage, stratified sampling (324 females and 309 males). Body weight and height were measured with a sliding weight scale and height measure. Nasal cavity cross-sectional areas were measured via acoustic rhinometry. Results: We observed parallel increases in the evaluated anthropometric measurements and nasal cavity cross-sectional areas both in males and females aged ≤ 14 years, with the two sexes starting to differ significantly in terms of those measurements over the age of 14 (p < 0.0001; p < 0.000001). The evaluated rhinometric measurements showed a greater correlation with height than with body weight. The time of the most diversified and dynamic changes in anthropomorphic measurements was the age of > 12 years: with boys demonstrating significantly higher mean values of height and body weight than girls. Conclusions: Height showed a better correlation with rhinometric measurements (cross-sectional area of the nasal cavity) in younger subjects (at their age of development) than in older ones.

The normal ranges of selected acoustic rhinometry parameters depending on age and sex-component of standarization in nasal provocation test.

Introduction: Acoustic rhinometry is a non-invasive method of measuring intranasal spaces. As one of the objective techniques for nasal patency, it plays a critical role in evaluating the nasal allergen challenge.Aim: To establish the typical ranges of selected AR parameters for age and sex. Material and methods: The study was conducted in a group of 583 randomly selected subjects (329 females and 254 males). Acoustic rhinometry was done before and 15 min after a two-time application of 0.1% solution of the decongestant xylomethazoline. The evaluated AR parameters (the cross-sectional area 1 (CSA-1) at the level of the isthmus nasi and the distance between the external nares and the isthmus nasi (dCSA-1)) were measured separately for both nasal cavities. Another evaluated parameter was the mean CSA measured 3 cm beyond CSA-1 on the AR curve (CSA-3). Results: The site of the minimum CSA on the acoustic rhinometry curve in the study group was the second notch on the acoustic rhinometry curve (CSA-1), corresponding to the nasal isthmus. With increasing age of the subjects, we observed a systematic increase in nasal spaces. The difference between sexes reached statistical significance at the ages of 17 years and older. Conclusions: The evaluated males show larger nasal cavity volumes than females. The difference between the sexes reaches statistical significance at older ages.

Analysis of Intracranial Pressure Pulse-Pressure Relationship: Experimental Validation.

The slope of linear relationship between the amplitude of pulsations in intracranial pressure (ICP) versus mean ICP has recently been suggested as a useful guide for selecting patients for shunt surgery in normal pressure hydrocephalus (NPH). To better understand how the pathophysiology of cerebral circulation influences this parameter, we aimed to study the relationship between mean pressure and pulsation amplitude in a wide range of conditions affecting cerebrovascular tone and ICP in experimental conditions.We retrospectively analysed experimental material collected previously. Three physiological manoeuvres were studied in 29 New Zealand white rabbits: lumbar infusion with an infusion rate ≤0.2 mL/min to induce mild intracranial hypertension (n = 43), sympathetic blockade to induce arterial hypotension (n = 19), and modulation of the ventilator tidal volume, simultaneously influencing arterial carbon dioxide partial pressure (PaCO2) to induce hypocapnia or hypercapnia (n = 17). We investigated whether the slope of the pulse amplitude (AMP)-ICP line depended on PaCO2 and arterial blood pressure (ABP) changes.We found a linear correlation between AMP-ICP and ICP with positive slope. Regression of slope against mean ABP showed a negative dependence (p = 0.03). In contrast, the relationship between slope and PaCO2 was positive, although not reaching statistical significance (p = 0.18).The slope of amplitude-pressure line is strongly modulated by systemic vascular variables and therefore should be taken as a descriptor of cerebrospinal fluid dynamics with great care.

Critical Closing Pressure During a Controlled Increase in Intracranial Pressure.

OBJECTIVES: The objectives were to compare three methods of estimating critical closing pressure (CrCP) in a scenario of a controlled increase in intracranial pressure (ICP) induced during an infusion test in patients with suspected normal pressure hydrocephalus (NPH). METHODS: We retrospectively analyzed data from 37 NPH patients who underwent infusion tests. Computer recordings of directly measured intracranial pressure (ICP), arterial blood pressure (ABP) and transcranial Doppler cerebral blood flow velocity (CBFV) were used. The CrCP was calculated using three methods: first harmonics ratio of the pulse waveforms of ABP and CBFV (CrCPA) and two methods based on a model of cerebrovascular impedance, as a function of cerebral perfusion pressure (CrCPinv), and as a function of ABP (CrCPninv). RESULTS: There is good agreement among the three methods of CrCP calculation, with correlation coefficients being greater than 0.8 (p < 0.0001). For the CrCPA method, negative values were found for about 20% of all results. Negative values of CrCP were not observed in estimators based on cerebrovascular impedance. During the controlled rise of ICP, all three estimators of CrCP increased significantly (p < 0.05). The strongest correlation between ICP and CrCP was found for CrCPinv (median R = 0.41). CONCLUSION: Invasive CrCP is most sensitive to variations in ICP and can be used as an indicator of the status of the cerebrovascular system during infusion tests.

Effect of the nasal cycle on congestive response during bilateral nasal allergen provocation.

BACKGROUND: Bilateral nasal allergen provocation usually produces more pronounced obstruction of one nasal passage. It was found that this could be related to the stage of the nasal cycle before the provocation. OBJECTIVE: To discover whether the stage of the nasal cycle is decisive for asymmetry in congestive response observed during bilateral allergen nasal provocation. methods. Two bilateral nasal allergen provocations were performed in a group of 26 pollen-sensitive volunteers. Acoustic rhinometry measurements were taken during the nasal cycle, and then after the provocation. A cross-sectional area at the level of the inferior turbinate (CSA-2) was measured. Consecutive challenges were performed in the opposite phase of the nasal cycle: the side which had been wide just before the first challenge, was narrow before the second provocation. RESULTS: Asymmetry in CSA-2 reduction between the nasal passages was observed in most cases. Significant difference was observed between mean CSA-2 reduction rate (reactivity) of the side that responded with greater congestion, and the opposite side. No significant difference was found in mean CSA-2 reduction rate between the side which was narrow, and the side which was wide before provocation. CONCLUSIONS: Asymmetry of congestive response during bilateral nasal allergen provocation is not dependent on the stage of the nasal cycle preceding the challenge.

[Comparative analysis of the treatment results of the nasal obstruction using septoplasty and septokonchoplasty]. / Analiza porównawcza wyników leczenia zaburzen droznosci nosa z zastosowaniem septoplastyki i septokonchoplastyki.

The nasal septal deviation coexistent with turbinate hypertrophy is considered one of the most common causes of nasal patency disorders. There is no doubt that septoplasty in most such cases is a proper treatment method. It is more difficult to clearly identify indications and predict the consequences of septoconchoplasty. The main aim of this study is to compare the impact of each of these procedures on subjective and objective measures of nasal patency. The authors retrospectively reviewed 132 medical records of patients treated in the Department of Otolaryngology, Medical University of Warsaw in the period from March 2012 to January 2013 due to nasal obstruction. Each patient had septoplasty or septoconchoplasty performed. Before treatment, each patient responded to questions in a standardized questionnaire SNOT 20. In addition, each patient was performed upon for anterior rhinomanometry before and after shrinking the nasal mucosa. Finally, the study involved a group of 30 people - 15 after septoplasty (group A) and the same number after septoconchoplasty (group B), who attended control examination carried out by the same scheme 6 weeks and 6 months after surgery. SNOT 20 poll was repeated 6 months after surgery. Analysis of the rhinomanometry results showed no statistically significant differences between the two treatment groups. Average values of the nasal resistance after surgery as compared to their baseline values in all measurements were smaller in each of the groups but the differences were also not statistically significant. However, comparing the results of the subjective assessment of nasal patency and associated signs and symptoms showed statistically significant differences between pre and postoperative results in both groups and the patients of group B felt more improvement than patients in group A. The study authorizes the conclusion that in justified cases septoconchoplasty gives better results than septoplasty.

New clinical insights for transiently evoked otoacoustic emission protocols.

BACKGROUND: The objective of the study was to optimize the area of a time-frequency analysis and then investigate any stable patterns in the time-frequency structure of otoacoustic emissions in a population of 152 healthy adults sampled over one year. MATERIAL/METHODS: TEOAE recordings were collected from 302 ears in subjects presenting normal hearing and normal impedance values. The responses were analyzed by the Wigner-Ville distribution (WVD). The TF region of analysis was optimized by examining the energy content of various rectangular and triangular TF regions. The TEOAE components from the initial and recordings 12 months later were compared in the optimized TF region. RESULTS: The best region for TF analysis was identified with base point 1 at 2.24 ms and 2466 Hz, base point 2 at 6.72 ms and 2466 Hz, and the top point at 2.24 ms and 5250 Hz. Correlation indices from the TF optimized region were higher, and were statistically significant, than the traditional indices in the selected time window. CONCLUSIONS: An analysis of the TF data within a 12-month period indicated a 85% TEOAE component similarity in 90% of the tested subjects.

Dynamics of early phase congestion after nasal allergen provocation.

BACKGROUND: It is generally accepted that congestion during the nasal provocation is most pronounced at about 15 minutes after allergen application. However, it may reach its peak at a different time. This can cause inaccurate assessment of the nasal challenge. The aim of this study was to evaluate the dynamics of early phase congestion during nasal allergen provocation (NPT) and its reproducibility. METHODS: Two nasal allergen challenges were performed in 26 allergic rhinitis volunteers. Acoustic Rhinometry measurements were recorded beJbre, and then every 5 minutes/for 30 minutes after the allergen application. The sum of cross-sectional areas at the level of the head of inferior nasal turbinate (CSA-2) of both nasal passages was analyzed. RESULTS: The mean time to the occurrence of maximum congestion was 20 minutes. The maximum congestion differed significantly from that recorded at 10, 15 and 20 minutes. The observed patterns of congestive response were not consistent, with inter- and intra-individual differences regarding the time to maximum congestion. Percentage change in airway dimension recorded at the maximum congestion was found the least variable. CONCLUSIONS: Evaluation of the maximum congestion pattern during the NPT gives more accurate data compared to a single measurement of nasal patency.

Changes in nasal cavity dimensions in children and adults by gender and age.

OBJECTIVE: The aim of the study was to establish the dynamics of changes in the intranasal spaces of children and adults by gender and age. MATERIALS AND METHODS: Each side of the nasal cavity was evaluated separately in 366 healthy subjects 9 to 74 years old. The following acoustic rhinometry parameters were analyzed: 1) I-C, distance between the isthmus nasi (I) and the head of the inferior turbinate (C); 2) CA-I, cross-sectional area at the isthmus nasi; 3) CA-C, at the head of the inferior turbinate; and 4) CA-F, the highest point on the rhinometric curve between points I and C. RESULTS: Before age 11 years, the intranasal spaces were slightly larger in girls than in boys. After age 11 years the nasal parameters were larger in boys than in girls. The growth rates before age 17 years were as follows: I-C: 0.073 cm/yr, 0.135 cm/yr, CA-F: 0.055 cm2/yr, 0.133 cm2/yr (P < .00001), and CA-C: 0.010 cm2/yr, 0.034 cm2/yr (P < .02) in girls and boys, respectively. In subjects older than 16 years, the mean values of I-C were 1.707 cm, 1.934 cm (P < .0001), and of CA-C, 0.493 cm2, 0.611 cm2 (P < .0001) in women and men, respectively, and changed slightly over the year. CONCLUSIONS: The parameters of intranasal spaces depend on age and gender. The dynamics of the changes is greater in boys than in girls and usually the growth is completed by the age of 16. After this age, nasal cavities are bigger in men than in women.

[An evaluation of the usefulness of impulse-current stimulation in electrogustometry--preliminary report]. / Ocena przydatnosci stymulacji pradowo-impulsowej w elektoustometrii--doniesienie wstepnei.

UNLABELLED: Electrogustometry is a simple and fast method of quantitative taste examination. The direct-current monopolar stimulating equipment was most frequently used until now. Aim of the study was to evaluate usefulness of the new method based on bipolar stimulation with impulse-current Furthermore, the authors wanted to determine taste thresholds using the equipment. MATERIAL AND METHODS: 50 healthy volunteers (25 women and 25 men) in the age of 17-50 were involved. The volunteers had a careful otolaryngological examination. Then the taste thresholds for each quarter of tongue were determined using the new equipment. Additionally, ten of the group of volunteers was examined in accordance to repetition time values. RESULTS: the determined values showed symmetry of taste thresholds, among the range of 4.9-26 microA for anterior 2/3 of the tongue and 41.5-93 microA for the 1/3 posterior. The examination with consideration to repetition time did not show increase of taste threshold after ten minutes stimulation. CONCLUSIONS: in conclusion the new kind of electrogustometry is precision and repeatable taste diagnostic method. Moreover the way of stimulation does not cause the phenomena of fatigue and adaptation.

Effects of impulse noise on transiently evoked otoacoustic emission in soldiers.

The aim of the study was to assess the effects of exposure to impulse noise on TEOAE, as compared to PTA. The study comprised 92 soldiers, subjected to impulse noise during military service. The control group consisted of secondary school students, not exposed to noise. Extended high frequency PTA, and TEOAE were recorded before and after one year of military service. The total level of noise and spectrum analysis were performed for all kinds of weapons, separately. The highest levels of noise for weapons were related to frequencies from 1.6-16 kHz. After military service significant deterioration of hearing was observed on average by 6 dB exclusively at the frequencies of 10 and 12 kHz. TEOAE reduction was registered predominantly at frequencies of 2, 3 and 4 kHz, with the greatest decrease at 2 kHz (p <0.02). The control group did not show any significant audiometric changes as well as TEOAE during the time of experiment.

Identification of otoacoustic emissions components by means of adaptive approximations.

Clicks and a set of tone bursts covering the same frequency band were applied as a stimuli evoking otoacoustic emissions (OAE). Recorded otoacoustic emissions were decomposed into the basic waveforms by means of high-resolution adaptive time-frequency approximation method based on the matching pursuit algorithm. The method allows for description of the signal components in terms of frequencies, time occurrences, time spans, and energy. The analysis of OAE's energy density distributions in time-frequency space revealed that click responses can be considered as linear superpositions of responses to tone bursts, The frequency-latency relationship was studied and compared with earlier works. The method made possible the exhaustive description of the resonant modes specific for given subject/ear. They were characterized not only by the close frequencies appearing for different tones, but they usually had similar latencies and time spans. Short-time and long-time resonant modes were identified. The second ones might be connected with spontaneous emissions. The method opens new perspectives in studying the fine structure of the OAE and testing of the theoretical models.

[Personal long-term reproducibility of the TEOAE time-frequency distributions]. / Osobnicza powtarzalnosc obrazów analizy czasowo-czestotliwosciowej TEOAE.

The TEOAE signal is relatively short and content changes in time. Due to the fact that signal is very short (20 ms) a special approach must be applied for the analysis of this nonstationarity. Usually the spectral estimation in TEOAE is based on procedures directly employing the fast Fourier transform (FFT). Because TEOAE signal is non stationary the classical Fourier analysis is not adequate for this signal. The aim of our study was the personal comparison of the TEOAE spectograms by using Wigner-Ville distribution (WVD) before and after one year period. Material consisted of 152 men (304 ears) in the age between 18-19 year with good quality OAE. After one year period the comparison of WVD spectrograms showed the highest similarity in the 274 ears (90%), less in the 24 (8%) and in 6 (2%) similarity was not noticed. Personal similarity of the spectrum TEOAE and differences between individual people's ears despite a long time, give a proof about individual architecture of outer hearing cell and maybe useful in the biometrics as a ear-print.