Correlations between acoustic rhinometry, subjective symptoms, and endoscopic findings in symptomatic children with nasal obstruction.

IMPORTANCE: Nasal obstruction is common in children and difficult to quantify objectively. Symptom quantification is paramount for surgical and medical decision making. Acoustic rhinometry is a relatively new technique aimed at the objective assessment of nasal obstruction. There is no standardized method for the objective assessment of the pediatric nasal airway. OBJECTIVE: To explore the correlations between acoustic rhinometry (AR), subjective symptoms, and endoscopic findings in children presenting with nasal obstruction. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, exploratory, diagnostic study of prospectively collected data from a multidisciplinary airway clinic (pulmonology, orthodontics, and otolaryngology) database at a tertiary academic referral center. Data were collected over a 2-year period (2010-2012) from 65 nonsyndromic children (38 boys) 7 years and older (mean [SD] age, 10.3 [2.5] years [range, 7-14 years]), presenting with persistent nasal obstructive symptoms for at least 1 year, without signs and symptoms of sinus disease. INTERVENTIONS: We collected patient demographics and medical history information including allergy, asthma, and sleep-disordered breathing. Subjective nasal obstruction was scored using a visual analog scale (VAS). Sleep-disordered breathing was assessed using overnight pulse oximetry. The adenoid size, septal position, and visual severity of chronic rhinitis (endoscopic rhinitis score [ERS]) were rated on nasal endoscopy by 2 independent reviewers and validated by agreement. Acoustic rhinometry (AR) was undertaken before and after use of a decongestant. MAIN OUTCOMES AND MEASURES: Correlation and multiple regression analyses were performed to explore interrelationships between subjective nasal obstruction VAS, AR, and nasal endoscopy. RESULTS: Among the 65 patients, 28 (43%) had symptoms of sleep-disordered breathing, 14 (22%) had allergic rhinitis, 10 (15%) had asthma, 27 (41%) had grade 3 or 4 adenoidal obstruction, 28 (43%) had an ERS of 2, 6 (9%) had an ERS of 3, and 19 (29%) had septal deviation. Significant correlations were found between subjective nasal obstruction VAS score and ERS (r = -0.364, P = .003), ERS and minimal cross-sectional area before decongestion (r = -0.278, P = .03), and adenoid size and calculated nasal resistance after decongestion (r = 0.430, P < .001). Multiple regression analysis showed that the ERS was the only significant predictor of VAS score (ß of -22.089; 95% CI, -35.56 to -8.61 [P = .002]). No predictors were identified for AR variables. CONCLUSIONS AND RELEVANCE: Among the evaluated tools, endoscopy appears to be the most reliable tool to estimate the degree of subjective nasal symptoms.

Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis.

BACKGROUND: The authors conducted a systematic review to consolidate the current knowledge regarding craniofacial morphological characteristics associated with obstructive sleep apnea syndrome (OSAS) in nonsyndromic pediatric patients. TYPES OF STUDIES REVIEWED: The authors included clinical studies in which participants were younger than 18 years, polysomnography was performed to determine the presence and severity of OSAS and the study group was compared with a control group or normative growth center data. The authors excluded studies with syndromic participants or participants who had received orthodontic treatment, orthognathic treatment or both previously. RESULTS: The authors identified nine articles. They conducted a meta-analyses of the data from all but one of the studies to evaluate the eight most common cephalometric variables in children with OSAS. The I(2) values were 79.53 percent for the angle from the basion point to the sella nasion (SN) line, 89.54 percent for the angle between the SN and palatal plane lines and 96.82 percent for the angle between the mandibular plane and SN lines (MP-SN). Therefore, for these three variables, the authors conducted a random-effect model meta-analysis. For the remaining five variables (MP-SN, the angle from SN to Apoint, the angle from SN to B point [SNB], the angle from A point to nasion point to B point [ANB] and the angle from articulare point to gonion point to gnathion point), I(2) values were all less than 40 percent, and therefore the authors conducted a fixed-effects model meta-analysis. Three of the evaluated cephalometric variables (MP-SN, SNB and ANB) had statistically significant differences in comparison with those in a control group. Although the values of these variables were increased in children with OSAS, results of the meta-analysis should be considered cautiously owing to the limited number of cephalometric variables included. PRACTICAL IMPLICATIONS: Dentists who identify patients with a craniofacial morphology consistent with pediatric OSAS (retrusive chin, steep mandibular plane, vertical direction of growth and a tendency toward Class II malocclusion) should inquire further into their patients' medical histories. When the craniofacial morphology is accompanied by a history of snoring, inability to breathe through the nose, significant allergies, asthma or obesity, the dentist should refer the patient to an otolaryngologist for assessment.