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Computational fluid dynamics （CFD） analysis is useful for quantitative assessment in patients with upper airway obstructions. We compared CFD analysis with rhinomanometry （RM） and acoustic rhinometry （AR）. Twenty patients with nasal and paranasal diseases who required computed tomography assessment underwent RM and AR. We measured the pressure and velocity at four parts of the upper airway using CFD analysis. Then we evaluated the correlation among CFD analysis, RM, and AR. CFD analysis detected obstruction sites in the nasal airway and pharynx in 14 and 2patients, respectively. High negative pressure accompanied the nasal obstruction, even behind the nasal cavity. Nasal airway pressure measured using CFD analysis strongly correlated with nasal resistance in RM （Spearman correlation coefficient＝0.853）. CFD analysis’s sensitivity and specificity to detect the obstruction were 84.6％ and 57.1％, respectively （compared to those of RM） and 83.3％ and 50.0％, respectively （compared to those of AR）. The CFD analysis’s ability to detect obstruction was comparable to that of RM and AR; therefore, it may help evaluate the upper airways in patients with nasal and paranasal diseases. We found impaired nasal ventilation also affected other parts of the upper airway. Further studies with a larger sample size are required to validate the use of CFD analysis for assessing the degree of upper airway ventilation disorders.

Computational fluid dynamics （CFD） analysis is useful for quantitative assessment in patients with upper airway obstructions. We compared CFD analysis with rhinomanometry （RM） and acoustic rhinometry （AR）. Twenty patients with nasal and paranasal diseases who required computed tomography assessment underwent RM and AR. We measured the pressure and velocity at four parts of the upper airway using CFD analysis. Then we evaluated the correlation among CFD analysis, RM, and AR. CFD analysis detected obstruction sites in the nasal airway and pharynx in 14 and 2patients, respectively. High negative pressure accompanied the nasal obstruction, even behind the nasal cavity. Nasal airway pressure measured using CFD analysis strongly correlated with nasal resistance in RM （Spearman correlation coefficient＝0.853）. CFD analysis’s sensitivity and specificity to detect the obstruction were 84.6％ and 57.1％, respectively （compared to those of RM） and 83.3％ and 50.0％, respectively （compared to those of AR）. The CFD analysis’s ability to detect obstruction was comparable to that of RM and AR; therefore, it may help evaluate the upper airways in patients with nasal and paranasal diseases. We found impaired nasal ventilation also affected other parts of the upper airway. Further studies with a larger sample size are required to validate the use of CFD analysis for assessing the degree of upper airway ventilation disorders.

Nasal obstruction is one of the most popular symptoms caused by the diseases of nose and paranasal sinus. We use rhinomanometry （RM） and acoustic rhinometry （AR） to evaluate the nasal patency objectively. RM is a physiological examination indicating the nasal resistance as an index of nasal patency. On other hand, AR is a morphological examination which could measure the cross-sectional area of nasal cavity. As unilateral nasal patency spontaneously changes in human beings, often referred to as‘ nasal cycle’, single measurement not seldom has insufficient reliability. Therefore, several measurements often are necessary to increase the accuracy of the examinations.

Background: The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. Methods: All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. Results: A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Conclusion: Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The role of inferior turbinate hypertrophy in the reduction of nasal airflow is well established. Although chronic nasal obstruction is not life- threatening, it significantly impairs patients’ quality of life, affecting many aspects of daily activities; therefore, patients seek medical intervention. 40 patients were selected (27 males and 13 females) between 27 and 64 years of age with a symptom of nasal obstruction. The patients were divided in two groups: Group 1: coblation, 25 patients (18 males and 7 females); Group 2: radiofrequency, 15 patients (7 males and 6 females). These 40 patients were followed for 3 years. Patients were analyzed using both subjective and objective methods. The visual analog scale (VAS) subjective data and objective data including both active anterior rhinomanometry and acoustic rhinometry were recorded and analyzed. Data were collected pre-operatively and at 1 and 3 years post-operatively. According to our data, both coblation and radiofrequency turbinate reduction benefit patients with good results. The complications, found during the follow-up, are limited to minimal bleeding and crusting. Coblation and radiofrequency were significantly less painful than others procedures during the early post-operative period. In our study, both coblation and radiofrequency provide an improvement in nasal airflow with a reduction in nasal obstructive symptoms in the short term, but their efficacy tended to decrease within 3 years.

Objective: Palate lung nasal epithelial clone (PLUNC) is a family of proteins, which are proposed to participate in the innate immune defense against infections in the upper aero-digestive tract. The aim of this study was to investigate the expression of SPLUNC1 in allergic rhinitis subjects with considerations taken to the mucosa( function and smoking habits. Methods: The participants, recruited from a cohort followed from infancy, were re-examined at the age of 18 years regarding allergy development. Based on medical histories and skin prick tests the participants were classified into groups with persistent allergic rhinitis (n = 18), intermittent allergic rhinitis (n = 8) and healthy controls (n = 13). Seven subjects (3, 2 and 2 in each group, respectively) reported smoking habits. The SPLUNC1 levels in nasal lavage fluids were analyzed by Western blot. Changes in the volume of the proper nasal cavity before and after physical exercise (Vol2(increase)) were analyzed by acoustic rhinometiy. Results: Compared to the control group the SPLUNC1 level was significantly lower in the persistent allergy group (3.8 +/- 3.4 OD vs. 1.3 +/- 1.5 OD; p = 0.02), but not in the intermittent allergy group without current exposure to allergens (3.6 +/- 4.7 OD). No differences were found in Vol2(increase) between any of the allergy groups and controls. In smokers Vol2(increase) was significantly reduced (p < 0.01) and the SPLUNC1 levels were lower compared to non-smokers. A significant correlation was found between SPLUNC1 and vol2(increase) (p<0.01; r = 0.53) in non-smokers. Conclusions: Current allergen exposure has an impact on SPLUNC1 expression in nasal lavage fluid, why allergy ought to be considered in study populations where analyses of SPLUNC1 levels are included in the reports. The normal nasal decongestion after exercise was not affected by allergy in contrast to smoking habits. The correlation between SPLUNC1 levels and Vol2(increase) in non-smokers may indicate in

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The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3--4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm

Objective: This study aimed to analyze upper and lower airway function and the impact of smoking habits in a cohort of allergic and healthy adolescents. The influence of smoking habits on the outcomes of rhinitis and asthma is well documented, but only few reports are available showing smoke related upper airway impairment by rhinometric measurements, and none with focus on early changes in adolescents. Methods: A cohort followed from infancy was re-examined at the age of 18 years concerning allergy development. Acoustic rhinometry (VOL2), spirometry (FEV1) and measurements of nitric oxide levels from the upper (nNO) and lower airways (eNO) were performed before and after physical exercise, and smoking habits were registered. Results: Active smoking habits were reported by 4/21 subjects suffering from allergic rhinitis, by 1/4 from probable allergic rhinitis, by 0/3 subjects with atopic dermatitis and by 2/10 healthy controls. Smoking habits were reported as daily by 2 and occasional by 5 of the 7 active smokers. VOL2 did not increase in smokers after exercise as in non-smokers, resulting in a post-exercise group difference (7.3 +/- 1.1 cm(3) vs. 8.8 +/- 1.5 cm(3); p = 0.02), and FEV1 values were lower in smokers compared to non-smokers (89 +/- 7% vs. 98 +/- 8%; p 0.02). The nNO and eNO levels were, however, only slightly reduced in smokers. Airway allergy was discerned only in subjects with current allergen exposure by increased eNO levels compared to healthy controls (41 +/- 44 ppb vs. 13 +/- 5 ppb). The levels of VOL2, nNO and FEV1 did not differentiate allergic subjects from healthy controls. Conclusions: Low levels of tobacco smoke exposure resulted in reduced airway functions in this adolescent cohort. Acoustic rhinometry and spirometry were found to be more sensitive methods compared to nitric oxide measurements in early detection of airway impairment related to smoke exposure. A possible difference in airway vulnerability between allergic and healthy subject

Despite the decreased use of solvent-based paint (SBP) and increased use of water-based paints (WBP) with possible risk for microbial growth, few health studies are available. The aim was to study the symptoms and ocular and nasal biomarkers in house painters in relation to paint use and personal exposure to volatile organic compounds (VOC) and microbial VOC (MVOC) during indoor painting with WBP. All house painters from three major companies and unexposed controls (janitors from one company) were invited, 94% (N = 31) and 95% (N = 20) of non-asthmatics participated, respectively. Tear film break-up time (BUT), nasal patency by acoustic rhinometry, and biomarkers in nasal lavage (NAL) were measured at work, and a doctor's administered questionnaire was answered. Personal sampling (8 h) of formaldehyde, VOC, and MVOC was performed in 17 house painters using WBP. House painters had increase in ocular symptoms, decreased BUT, and increased NAL-lysozyme, when compared to controls. Painters reporting mucosal irritation from WBP had less nasal patency and higher NAL-myeloperoxidase (NAL-MPO). A large proportion of the VOC consisted of propylenglycol, diglycol ethers, and Texanol. There was an association between 8-h exposure to propylene glycol and NAL-eosinophilic cationic protein (NAL-ECP), 2-phenoxyethanol levels and reduced BUT, sum of aliphatic glycol ethers and increased NAL-MPO. Increased levels of 1-octen-3-ol, one MVOC, were related to reduced nasal patency and increase in NAL-MPO. House painters may have a risk for adverse physiological reactions in the ocular and nasal mucosa. A minority of painters susceptible to WBP can react with neutrophilic nasal inflammation. Different chemicals in the paint could cause either neutrophilic or eosinophilic inflammation, or reduced tear film stability. In addition, house painters are exposed to MVOC which may affect the nasal mucosa.

To improve results in septal surgery, patient selection is the mainstay of a successful outcome. Patient history is the basis as well as clinical examination but both are subjective and must be considered towards a background with a high frequency of septal deviation in the population and a lack of good correlation between function and status. Rhinomanometry and acoustic rhinometry as well as nasal peak inspiratory flow are tests of different nasal parameters as resistance to breathing, nasal dimensions and flow. This article illuminates the use of these more objective tests in selection of patients for septoplasty. Objective tests have in several studies shown to predict postoperative satisfaction while normal values can be a marker for a poor surgical outcome. Pros and cons with objective tests are discussed and the conclusion is: operate when there is a good correlation between the patient's status, history and the results of rhinometry!

CONCLUSION: The methods used in this study are suitable for field studies that involve examinations of groups of workers. For individual examinations, there is no gold standard method that can discriminate work-related discomfort from other causes of rhinitis. OBJECTIVES: Studies of the effects of occupation on farmers' health have mainly focused on lower airways; few studies have examined effects on upper airways. This study investigated nasal functions in three groups of farmers (swine, milk and grain producers) and a control group using different methods, suitable for field studies. SUBJECTS AND METHODS: Health-related complaints were examined and several functional tests, such as expirogram, olfactory threshold test, acoustic rhinometry, nasal lavage with biomarkers of inflammation (eosinophilic cationic proteins (ECP), myeloperoxidase (MPO), tryptase, albumin) and allergy tests were performed. The different tests were correlated to nasal complaints and to each other. RESULTS: Nasal blockage complaints were more common among farmers; overall, nasal polyps were more frequent in grain producers. Objective parameters showed more pronounced mucosal swelling in farmers and higher concentrations of ECP in nasal lavage compared with controls. Lung function, olfactory threshold, atopy frequency and allergen-specific IgE to the storage mite Lepidoglyphus destructor did not differ between farmers and controls. Mucosal swelling measured with acoustic rhinometry was more pronounced in subjects with nasal complaints, hypersensitivity, nasal polyps and symptoms from lower airways. There was a correlation between biomarkers in nasal lavage (MPO, albumin and ECP).

OBJECTIVES: Increased morbidity and mortality in lower airway diseases have been reported among farmers. The aim of this study was to assess upper airway problems in farmers. SUBJECTS AND METHODS: Twenty-five dairy farmers, 20 pig farmers, 21 grain farmers and 19 control subjects were studied, by use of questionnaire, skin-prick test, dynamic spirometry, nasal inspection, acoustic rhinometry (before and after a decongestant) as well as by determinations of the olfactory threshold and nasal lavage (NAL) concentrations of eosinophil cationic protein (ECP), myeloperoxidase (MPO) and albumin. RESULTS: Compared with the control group, farmers had more complaints of work-related symptoms from the lower airways, and symptoms of smell impairment, and more often had nasal polyps and hyperaemia of the nasal mucosa. They also had higher levels of MPO in NAL (especially dairy farmers and pig farmers), and a tendency to more swollen nasal mucosa and lower olfactory threshold (especially grain farmers). CONCLUSIONS: The farmers had more pathological findings in their nasal mucosa, possibly indicating effects of allergens and irritants in their work environment. More studies are needed to evaluate work environment factors causing these pathological findings in farmers.

In Sweden, 2 million persons are exposed to the school environment, and there has been reports on insufficient cleaning, and inadequate ventilation. The nasal mucosa is more easy to study than the lower airways, and rhinitis is common and possibly related to asthma. The main aim was to study nasal symptoms, nasal patency, and biomarkers in nasal lavage (NAL), in relation to exposures in schools. Acoustic rhinometry and nasal lavage were performed in 234 school personnel in 12 randomly selected schools in Uppsala. An extended study was made, including 89 office workers, and 88 hospital workers. The technical investigations comprised a building survey and measurements of ventilation flow, settled dust, respirable dust, formaldehyde, nitrogen dioxide (NO2), molds, and bacteria in the classroom air. A ventilation flow below current Swedish standard was found in 92% of the schools, and 42% did not follow the recommendation of daily cleaning. Nasal patency was decreased in schoolswith lower air exchange rate. In schools with older mechanical ventilation, based on dilution, there were more nasal symptoms than in naturally ventilated schools, and decreased nasal patency and increase of eosinophil cationic protein (ECP) and lysozyme in NAL. One school with a new type of displacement ventilation had the highest air exchange rate, increased nasal patency and lower ECP and lysozyme. Nasal symptoms were more common in schools with more settled dust. Beneficial effects on nasal patency, ECP and lysozyme in NAL were observed for higher cleaning frequency, particularly desk cleaning. Dry cleaning methods seemed preferable. Decreased nasal patency and higher concentrations of ECP and lysozyme were observed at higher indoor concentration of formaldehyde, NO2 and molds, particularly Aspergillus sp. This indicate increased eosinophil and glandular activity, and mucosal swelling, related to these exposures. In conclusion, the school environment may affect the nasal mucosa, with mucosal