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Background: Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. Objectives: The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients' symptoms, postoperative bleeding, crusting, and pain scores. Methods: This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group (n = 45), and submucous resection group (n = 45). The outcomes of both techniques were analyzed and compared. Results: Both techniques were equally in alleviating patients' symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. Conclusion: Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting. [ABSTRACT FROM AUTHOR]

Background: Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses. Objective: This systematic review summarizes the histopathologic and clinical tumor characteristics, surgical management, and follow-up of sinonasal leiomyomas. Methods: A systematic review of the literature on sinonasal leiomyoma was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that met the inclusion criteria were assessed for level of evidence. Patient demographics, clinical and pathological tumor characteristics, primary intervention, and results of follow-up were evaluated. Results: Forty studies including 84 patients with sinonasal leiomyoma were identified. The tumor was most often located in the nasal cavity (47/84, 56%) originating from the inferior turbinate (32/84, 38%). Patients mostly presented with symptoms originating from an intranasal mass, including recurrent epistaxis (41/84, 49%), nasal obstruction (43/84, 51.2%), and localized facial or head pain (25/84, 29.8%). Surgery was performed in all cases. An endoscopic approach was most frequently chosen. Recurrence occurred only twice (2.4%). Morbidity was noted in 2 cases (2.4%) following postoperative bleeding and 1 (1.2%) case following a CSF leak. Conclusion: Sinonasal leiomyomas are neoplasms of the smooth muscle manifesting clinically with recurrent epistaxis and nasal obstruction. Management goal is total resection with clear margins to avoid local recurrence. [ABSTRACT FROM AUTHOR]

Purpose: Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients. Methods: The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment. Results: One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (p < 0.001). Both the subjective (VAS and NOSE), both (p < 0.01) and objective (nasal FeNO, p < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve. Conclusion: Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) and eosinophilic esophagitis (EoE) are immune-mediated inflammatory conditions that share common histopathologic features. Once considered two separate pathologies, preliminary data has suggested that a higher prevalence of EoE may exist in patients with CRS. Objectives: We aimed to expand the base of evidence across geographic regions and investigate the association between EoE and CRS, including CRS with nasal polyposis (CRSwNP). Methods: Quantitative data detailing the prevalence of CRS, CRSwNP, and EoE were pooled from 6 large academic institutions spread across the United States using Epic electronic medical record system. One-way analysis of variance was then used to analyze the data. Results: The mean prevalence of EoE in our general population sample of over 26 million individual records was 0.058% (range, 0.013%-0.103%). The mean prevalence of EoE in our sub-populations of individual with diagnoses of CRS and CRSwNP was 0.43% (F(1,12) = [8.194], P =.01) and 0.84% (F(1,12) = [23.61], P <.01) respectively. Conclusion: This study reveals an 8-fold greater prevalence of concurrent EoE in patients with CRS. Importantly, this is the first study to describe the association of EoE and the CRSwNP subtype, and we demonstrate a 14-fold greater prevalence of EoE in patients with CRSwNP. [ABSTRACT FROM AUTHOR]

Background: Nonallergic rhinitis (NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of NAR. Objective: The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR. Methods: A systematic review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications. Results: In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled sample of 229 NAR patients that underwent EVN (n = 65; 28.4%), SPNN (n = 50; 21.8%), or CPNN (n = 114; 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding. Conclusion: EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN. [ABSTRACT FROM AUTHOR]

Background: Acute alcohol intake may influence nasal patency; however, there is lack of objective evidence. Objective: The aim of this study was to evaluate the effects of acute alcohol intake on nasal patency employing both subjective and objective measures. Methods: A total of 31 participants were classified into 2 groups of non-heavy drinkers (n = 17) and heavy drinkers (n = 14). Both groups consumed wine in 1 h and were assessed for subjective nasal symptoms and objective nasal patency, using rhinomanometry and acoustic rhinometry, at baseline and at 0.5, 2, and 6 h post-alcohol consumption. Results: Alcohol consumption significantly increased nasal obstruction from baseline values in both heavy and non-heavy drinking groups. Total nasal volume (TNV) and the minimal cross-sectional area (MCA) were significantly decreased and nasal airway resistance (NAR) significantly increased from baseline values by 2 h post-alcohol consumption for both heavy and non-heavy drinking groups (P <.05). Significant differences were found in TNV, MCA, and NAR between baseline and post-drinking in allergic rhinitis subjects; with no significant differences in MCA and NAR in subjects without allergic rhinitis. Pulse rate (PR) and temperature (T) were elevated, and blood pressure (BP) was decreased after alcohol consumption (P <.05). Blood alcohol concentration (BAC) was not significantly correlated with nasal patency with regard to any subjective or objective measurement. Conclusion: Acute alcohol consumption may impair nasal patency, independent of the amount consumed. Individuals with allergic rhinitis may be more prone to nasal obstruction after alcohol consumption than those without allergic rhinitis. [ABSTRACT FROM AUTHOR]

Objectives: Peak nasal inspiratory flow (PNIF) measurement is an inexpensive and user-friendly method to assess nasal patency. However, the repeatability of PNIF measurements, as well as the threshold value of a change in PNIF, which can be considered significant remain unclear. This study aims to investigate the repeatability of PNIF measurements and the change in PNIF after the administration of 0.05% oxymetazoline. Methods: Repeated measurements of PNIF (Clement Clarke In-Check nasal inspiratory flow meter; Clement Clarke International, Ltd, Harlow, Essex, UK) were obtained in 333 healthy volunteers (174 women). Based on age, participants were categorized into three groups (6–7 years, 13–14 years, and 20–45 years). We obtained five measurements in each participant. PNIF was remeasured in 294 subjects 30 min after administration of 0.05% oxymetazoline. The variability in PNIF measurements was assessed using the coefficient of variation (CV = standard deviation × 100%/mean). Results: The first four PNIF measurements significantly differed from each other. The difference in PNIF measurements ceased to be statistically significant only between the fourth and fifth measurements (p = 0.19). PNIF repeatability was acceptable; the median CV was 15.5% (0–66), which did not significantly differ between age groups. The administration of 0.05% oxymetazoline led to a statistically significant increase in the PNIF value by 14.3% (−45, 157%) (p = 0.000000). Conclusions: 1. No statistically significant difference was observed in PNIF values only between the fourth and fifth measurements; therefore, at least three measurements are essential to draw meaningful conclusions. 2. PNIF measurements were satisfactorily characterized by a relatively low CV (15%). 3. The administration of 0.05% oxymetazoline led to an increase in PNIF by approximately 14% over the baseline value. [ABSTRACT FROM AUTHOR]

Background: Sex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined. Objectives: The aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle. Methods: This study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin' Sticks test. Results: Statistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase. Conclusion: In the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle. [ABSTRACT FROM AUTHOR]

Background: Assessment of nasal obstruction is imprecise due to a low correlation between findings on the physical examination and objective measures with the severity of symptoms reported by the patient even after septoplasty with turbinoplasty is performed. The aim of this study is to evaluate the use of subjective scales, and the correlation between them for the evaluation of nasal obstruction after surgery. Objective: To assess the impact of undergoing septoplasty with turbinoplasty to relieve nasal obstructive symptoms and the quality of life in a mid-term period by using the Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), and Glasgow Benefit Inventory (GBI). Methods: A retrospective study was conducted of patients who underwent a septoplasty with turbinoplasty due to nasal septodeviation and secondary nasal obstructive symptoms at the Hospital Universitario Fundación Santa Fe de Bogotá. Three scales were used to measure the outcomes one year after surgery: VAS (0–10), NOSE (0–100), and GBI (−100 to 100). Results: Data from 56 patients (21 females, mean age 37.5 years of age, SD 12.13) was collected. The results showed that 75% of the patients had a post-surgical NOSE score below 50 and a VAS score below 6. Regarding the GBI scale, 75% of the patients improved in their quality of life. An inverse proportional correlation was found between the NOSE and GBI scales (rho = −0.3682) (95% CI −0.579 to –0.111), and there was a directly proportional correlation between the NOSE and VAS scales (rho = 0.7440) (95% CI 0.595 to 0.844). Conclusion: Subjective measures suggest there was an improvement in nasal obstructive symptoms and quality of life after surgery. Non-anatomical causes such as rhinitis can be confounding factors to consider in subsequent studies. VAS stands out as a possible interchangeable scale with NOSE to measure nasal obstruction in these patients. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnea is associated with an increased risk of male infertility, and one of its causes is deviated nasal septum with inferior turbinate hypertrophy (DNS/ITH). However, the risk of male infertility associated with DNS/ITH remains unclear. Methods: Using the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched cohort study to investigate the risk of infertility in male patients diagnosed with DNS/ITH (N = 61,761) from 2000 to 2015 in comparison with matched controls without DNS/ITH (N = 247,044). We further analyzed the effect of septoturbinoplasty (STP), including septoplasty and turbinoplasty, on the risk of male infertility in DNS/ITH patients. Results: At the end of the follow-up period, 46 (0.07%, 46/61,761, incidence rate: 6.25 per 100,000 person-years) patients developed infertility in the DNS/ITH group versus 72 (0.03%, 72/247,044, incidence rate: 2.28 per 100,000 person-years) in the control group; the incidence rate was 2.740-fold higher in the DNS/ITH group (log-rank P < 0.001). Cox proportional hazards regression revealed that the risk of infertility increased in the DNS/ITH group [adjusted hazard ratio (HR): 1.080, 95% confidence interval (CI), 1.049–1.514, P = 0.001]. Compared with the control group, the risk of infertility was highest in the DNS/ITH group without STP (adjusted HR: 2.842, 95% CI, 1.715–4.082, P < 0.001), followed by the DNS/ITH group with STP (adjusted HR: 1.074, 95% CI, 1.035–1.488, P = 0.012). The intervention of STP reduced the risk of infertility in the DNS/ITH group by 45.1% compared with those without STP (P = 0.033). Conclusion: Clinicians should be aware of the risk of infertility in male patients presenting with DNS/ITH. Improving the nasal airway by STP may decrease the risk of male infertility. [ABSTRACT FROM AUTHOR]

Background: The urban homeless population has increased exposure to risk factors associated with chronic rhinosinusitis (CRS). However, a gap in knowledge of the prevalence of sinonasal symptoms in these demographic limits complete understanding of CRS epidemiology. There is a need to elucidate sinonasal disease burden in this vulnerable patient population to bring awareness to any existing disparities. Objective: To assess the prevalence, severity, and associated factors of CRS clinical symptoms and health-care barriers in an urban homeless population. Methods: Homeless adults completed a sociodemographic questionnaire and the 22-item Sinonasal Outcome Test (SNOT-22) and EuroQol-5 Dimension-3 Level-Visual Analog Scale surveys. Responses were categorized by potential CRS symptoms defined as reporting at least 2 CRS cardinal symptoms. Risk factors associated with potential CRS symptoms were analyzed with multivariate regression models. Results: Fifty-six (16%) out of 341 total subjects reported potential CRS symptoms. Those with potential CRS symptoms had a higher median SNOT-22 score (53 vs 22, P <.001) than those without. Logistic regression models identified history of smoking (odds ratio [OR], 6.54; 95% confidence interval [CI], 2.04–21.04) and duration of homelessness over 3 months (OR, 3.46; CI, 1.51–7.94) as factors associated with potential CRS symptoms. Duration of homelessness over 3 months was associated with higher SNOT-22 scores (standardized beta coefficient [β], 0.48; CI, 0.39–0.57). Among those reporting 2 or more CRS cardinal symptoms, 18% had ever been seen by any physician for their symptoms. Conclusions: Our study estimates a high prevalence of potential CRS symptoms in the urban homeless population. Longer duration of homelessness was associated with potential CRS symptoms and poor CRS-specific quality of life scores. Disparities in access to care emphasize the need for increased preventive efforts designed for this unique patient group. [ABSTRACT FROM AUTHOR]

Background: The last 5 years have seen a surge of both clinical and scientific interest in empty nose syndrome (ENS). Although ENS is still considered a controversial diagnosis plagued by a lack of standardized diagnostic criteria, ENS is increasingly becoming recognized as a legitimate, physiologic disease entity. As such, it is important for clinicians to understand the most up-to-date diagnostic tools to assess ENS, confirm the diagnosis, and create a more standardized means to counsel these complex patients. Objective: Contemporary literature review to discuss diagnostic modalities in the evaluation of ENS, in order to introduce evidence-based diagnostic criteria. Methods: A systematic review was conducted in PubMed and Embase (2013–2019) using the search term "empty nose syndrome" to identify peer-reviewed articles on the topic of ENS. Articles advancing contemporary methods of ENS diagnosis and testing were included. A quality assessment was conducted using The Rational Clinical Examination Levels of Evidence. Results: The novel development of the Empty Nose Syndrome 6 Questionnaire (ENS6Q) offers the clinician a validated patient-reported outcome measure to supplement history and physical examination. The in-office cotton test, performed by placing an endoscopically directed cotton plug in the site of tissue loss, may help to identify patients who may benefit from turbinate augmentation. Tools such as the sinus computed tomography scan, computational fluid dynamics, and intranasal trigeminal nerve function testing currently have insufficient evidence to support routine use in the workup of ENS. Up to 66% of ENS patients present with comorbid anxiety or depression. Conclusion: The ENS6Q and cotton test assist in creating a standardized approach to the evaluation of patients suspected of ENS. These instruments should be used as an adjunct, rather than the sole criteria, on which to ascertain the presumptive diagnosis. Patients suspected of ENS should be screened for comorbid psychological dysfunction. [ABSTRACT FROM AUTHOR]

Background: Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective: This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods: Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results: Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH-LTRA on (1) composite nasal symptom score (standardized mean difference [SMD]: −0.20; 95% confidence interval [CI]: −0.36, −0.03), (2) rhinorrhea (SMD: −0.14; 95% CI: −0.27, −0.02), and (3) sneezing (SMD: −0.15; 95% CI: −0.27, −0.02). Subgroup analyses revealed that results favored the effects of AH-LTRA for perennial AR (SMD: −0.57; 95% CI: −0.87, −0.26) but not in the seasonal AR subgroup (SMD: −0.09; 95% CI: −0.21, 0.04), P =.004. There were no differences between AH-LTRA and AH on nasal obstruction, itching, ocular symptoms, Rhinoconjunctivitis Quality of life Questionnaire and adverse events. Due to limited number of included studies, effects on asthma and pediatric subgroups could not be assessed. Conclusion: For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR. [ABSTRACT FROM AUTHOR]

Background Mucociliary function is affected by temperature. Exposure to cold air may impair ciliary beat frequency. While saline nasal irrigation improves in ciliary beat activity, there is no evidence supporting the use of heated saline irrigation in treating patients with chronic rhinosinusitis. Objective To compare the effects of heated saline to room-temperature saline nasal irrigation on mucociliary clearance in chronic rhinosinusitis patients. Methods Adult patients with chronic rhinosinusitis were randomized into two groups receiving either heated saline or room-temperature saline nasal irrigation. Healthy subjects were included as control. Saccharin transit time was measured before and after nasal irrigation. Nasal patency was assessed by peak nasal inspiratory flow, anterior rhinomanometry, acoustic rhinometry, nasal obstruction score, and breathe-comfort score. Any adverse events were reported. Results Twenty-three patients with chronic rhinosinusitis and nine healthy subjects were enrolled. Saccharin transit time was decreased after nasal irrigation in both heated saline subgroup (baseline 12.3 ± 4.5 min vs. postirrigation 8.4 ± 4.9 min, p = 0.05) and room-temperature subgroup (baseline 12.8 ± 5.0 min vs. postirrigation 8.9 ± 4.2 min, p = 0.01). The saccharin transit time improvement was not different between heated saline (3.8 ± 6.2 min) and room-temperature saline (3.8 ± 4.0 min), p = 0.13. Postheated saline irrigation saccharin transit time of chronic rhinosinusitis patients (8.4 ± 4.9 min) was not different to healthy subjects (9.2 ± 3.7 min), p = 0.69. Nasal patency was not different between groups. There was no adverse event reported. Conclusion Nasal saline irrigation is beneficial to patients with chronic rhinosinusitis on mucociliary improvement. Warming saline is not necessary and adds no additional benefit to room-temperature saline irrigation. [ABSTRACT FROM AUTHOR]

Background: Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches. Objective: The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques. Methods: This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: 'nasal septum,' 'nasal obstruction,' 'nasal cartilages,' 'nose,' 'nose diseases,' 'surgery,' 'nasal/septal deviation,' and 'septoplasty.' All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals. Results: Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias. Conclusion: Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies. [ABSTRACT FROM AUTHOR]

Background: Respiratory epithelial adenomatoid hamartomas (REAH) are benign nose neoplasms found in the nasal cavity and sinuses. Symptoms include anosmia, nasal obstruction, facial pressure, and rhinorrhea. Although previously thought to be rare, these tumors are being increasingly recognized on pathology in patients undergoing endoscopic sinus surgery. However, REAH is difficult to diagnose before surgery because it may mimic other entities, such as nasal polyps or inverted papilloma, and is often found incidentally only after surgery. Objective: The aims of this study were to (1) add an additional case series of REAH to the literature, (2) report unique imaging findings on computed tomography and magnetic resonance imaging, and (3) pool and summarize all available data from existing publications. Methods: Retrospective chart review from years 2004 to 2015 and a literature review Results: Twenty-three cases were found in our case series, which included 12 men (52%) and 11 women (48%), with a mean age of 59 years. No cases were found before 2007. Lund-Mackay scores were comparable with those found in chronic rhinosinusitis without nasal polyposis. Imaging consistently demonstrated a discoid-shaped mass at the olfactory cleft. Fifty previous publications were found (4 prospective, 11 retrospective studies, 9 case series, 26 cases reports), which included 660 patients diagnosed with REAH. Pooled data revealed a mean age of 54 years (range, 9-86 years) and a male to female ratio of 3:2. Conclusion: The results of our study further refined the average age at which REAH diagnosis occurs as 54 years old, although it may occur at any age. There is a clear male-to-female predominance (3:2). In addition, olfactory cleft widening and discoid soft tissue at the olfactory cleft are hallmark radiographic findings. The vast majority of published cases occurred during the past 4 years, which indicated increased recognition of REAH. [ABSTRACT FROM AUTHOR]

Background: Nasal congestion and/or obstruction represents a prevalent and extensively studied problem. No published research exists that describes the impact of nasal hair (vibrissae) on nasal obstruction. Objective: To assess the impact of nasal vibrissae on subjective and objective measurements of nasal obstruction. Methods: In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae density and were treated with a topical decongestant. The subjects were then asked to subjectively assess nasal breathing by using four questions from the Nasal Obstruction Symptom Evaluation instrument before undergoing rhinomanometry. Nasal vibrissae were then trimmed, and the participants repeated the subjective and objective assessments. Pre- and postintervention outcomes, including symptom scores, nasal airflow, and resistance, were compared by using statistical analysis. Results: Statistically significant improvement was noted in subjects' nasal airway specific symptom scores and in objective measurements of their nasal airway. Patients with moderate or many vibrissae at baseline were noted to have greater likelihood of improvement in subjective and objective obstruction assessments than patients rated with few. Conclusion: In these 30 subjects, statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with greater density of vibrissae. These findings support further study of the potential benefit of the reduction of vibrissae density in some patients with nasal obstruction. [ABSTRACT FROM AUTHOR]

Background: Rhinoscleroma is a chronic granuloma that is endemic in Egypt and is caused by gram-negative bacilli (Klebsiella rhinoscleromatis). The nasal mucosa is affected in almost all cases, which causes nasal obstruction, anosmia, and epistaxis. The disease usually passes through an atrophic stage (atrophic rhinitis) and a granulomatous stage before ending in the fibrotic stage, with possible bone destruction. Objective: This study assessed the effect of topical mitomycin C (MMC) on reducing the recurrence of granulation tissue and intranasal adhesions after endoscopic debulking and continuous medical treatment of nasal rhinoscleroma. Materials and Methods: This double-blind randomized clinical trial was performed with 30 patients who had rhinoscleroma (granulomatous and fibrotic stages). At the end of endoscopic debulking, meshes impregnated with MMC was placed in one nasal cavity for 5 minutes, while another meshes impregnated with saline solution were placed in the opposite side. Repeated meshes with MMC were placed in the same side during the follow-up period. Patients were followed up for 1 year. The recurrence of granulation tissue and the degree of intranasal adhesions were recorded and compared according to the Lund-Kennedy score. Results: At 12 months' follow-up, among the total 30 patients, 30 MMC sides were compared with 30 control sides: 69% of MMC sides versus 32% of control sides had no recurrence of granulation tissue (p = 0.01) and 65% of MMC sides versus 24% of control sides had no recurrence of intranasal adhesions (p = 0.03). The Lund-Kennedy score decreased from 2.1 ± 0.64 to 0.8 ± 0.41 and from 2.3 ± 0.33 to 1.9 ± 0.20 in the MMC sides and control sides, respectively, with a nonstatistically significant lower incidence of intranasal adhesions in the MMC sides. Conclusion: Topical MMC may reduce granulation tissue and intranasal adhesion formation in patients with rhinoscleroma. Further studies with a larger number of samples and longer follow-up periods are recommended. [ABSTRACT FROM AUTHOR]

Objective: This article describes a simplified endonasal approach compared with traditional techniques for the correction of crooked noses by using endoscopic tension-relaxing septoplasty in the absence of nasal splints, with attempts to improve both the aesthetic appearance and functionality. Study Design: A retrospective study was conducted at our institution with all 26 patients who underwent tension-relaxing rhinoseptoplasty by endoscope between November 2008 and January 2013. Methods: Patients who were concerned about their aesthetic appearance and nasal obstruction were subjected to anterior rhinoscopy, endoscopic examination of the nasal cavity, and computed tomography for the evaluation of correlations among deformity of the nasal structures and nasal airway. The tension-relaxing method was used in the endoscopic rhinoseptoplasty by an endonasal approach. We introduced this technique in the surgery for patients with a C- or an I-shaped crooked nose. Subjective (visual analog scale) and objective (quantitative electronic meter measurement) assessments were used to evaluate aesthetic appearance. Validated Nasal Obstruction Symptom Evaluation scale and active anterior rhinomanometry were used to assess nasal obstruction. Results: All the patients indicated cosmetic satisfaction and reduced nasal obstruction. In cases with I-shaped and C-shaped crooked nose deformities, pre- and postoperative angle values (mean ± standard deviation) were 13.35 ± 3.36° versus 1.85 ± 1.66° (n = 15) and 153.69 ± 6.48° versus 176.64 ± 2.32° (n = 11), respectively. Postoperative correction rates were statistically significant (p < 0.001) in both groups. Results from active anterior rhinomanometry indicated significant improvement in objective nasal obstruction from a mean baseline value of 0.56 ± 0.07 Pa/cm3/s (range, 0.43- 0.69 Pa/cm3/s), to a 12-month value of 0.26 ± 0.02 Pa/cm3/s (range, 0.23-0.29 Pa/cm3/s) (p < 0.001). The mean rhinoseptoplasty duration time was 19.00 ± 3.53 minutes. The nose deformities were significantly improved, with no recurrences of septal deviation or crooked nose, nor complications of septal perforation and nasal infection 12 months after the operation. Conclusion: This simple technique is feasible and minimally invasive, and may be particularly beneficial to patients with a deviated septum who seek to improve both their aesthetic appearance and nasal functionality. However, this method is not appropriate for those with a crooked nose caused by nasal bone deformity, lateral cartilages, and severe septal deformity. [ABSTRACT FROM AUTHOR]

Background: Turbinectomy, although a common procedure, is often accused of having a negative impact in all nasal functions. This study is the first in vivo study that evaluates objectively the effect of partial turbinectomy on nasal air-conditioning capacity. Methods: In total, 57 patients with prior partial inferior turbinectomy and 28 healthy controls were examined. Intranasal temperature and humidity values were measured at the level of the head of inferior and middle turbinate. Nasal patency was evaluated by means of acoustic rhinometry. The clinical assessment was completed with nasal endoscopy and the Nasal Obstruction Symptom Evaluation questionnaire for subjective evaluation of nasal patency. Results: Significant changes of temperature were found in both detection sites with 13% reduced heating capacity of the air at the level of the inferior and 19% at the level of the middle turbinate, respectively. No similar results were found for humidity measurements. No correlations were found between air-conditioning values and acoustic rhinometry results for both study groups. Nasal endoscopy revealed normal healing in all patients. No major complications were reported by the patients. Their subjective ratings of nasal obstruction were similar to healthy controls. Conclusion: Partial turbinectomy seems to have a negative impact on intranasal air heating but not to humidification. This effect has no impact on clinical condition and subjective perception of surgical outcome. [ABSTRACT FROM AUTHOR]

Background: Inferior turbinate surgery is one of the most commonly performed methods for the treatment of rhinitis symptoms, especially nasal obstruction. This is a comparative study of CO2 laser, electrocautery, and radiofrequency turbinoplasty in the treatment of rhinitis symptoms. Methods: From 1994 to 2011, 3219 patients were enrolled in the study. Two hundred eighty-three patients were lost during follow-.up. Of the remaining 2936 patients, 1066 were managed using the CO2 laser, whereas 664 and 1206 were managed with the use of radiofrequency and electrocautery, respectively. All procedures were performed under local anesthesia. Patients were asked to evaluate their symptoms with the visual analog scale (VAS) preoperatively, as well as 1 month and 1 year postoperatively. Rhinomanometry was used to objectively evaluate the effect on nasal obstruction. Results: Mean VAS values preoperatively, regarding nasal obstruction, were 7.43 ± 0.96, 7.33 ± 0.87, and 7.64 ± 0.95 in the CO2 laser, radiofrequency, and electrocautery group, respectively. One month postoperatively, the score was significantly improved in all groups (CO2 laser, 3.44 ± 0.99; radiofrequency, 3.26 ± 0.76; electrocautery, 3.19 ± 0.79), which was almost stable in the 1st year of follow-up. Similar results were also observed in the evaluation of sneezing and rhinorrhea. Outcome did not statistically differ between the three methods. Conclusion: The CO2 laser, radiofrequency and electrocautery offer excellent postoperative results in turbinoplasty cases under local anesthesia. [ABSTRACT FROM AUTHOR]

Background: Internal nasal valve (INV) collapse can contribute significantly to nasal obstruction and may be caused by upper lateral cartilage (ULC) collapse medially or laterally. Surgical techniques addressing INV collapse have focused more on treating the narrowed INV angle, with less consideration of the lateral INV area. This article describes a technique to improve INV patency both medially and laterally. This study analyzes the changes in minimal cross-sectional area (MCA) at the INV after graft placement and determines whether these changes are significantly different for normal versus narrow INVs. Methods: Noses of six fixed cadavers were dissected by open rhinoplasty to release the ULCs from the septum. Upper lateral strut grafts were placed through subperichondrial pockets along the ULC undersurfaces and out over the piriform apertures into subperiosteal pockets. Grafts were secured to the dorsal septum. Acoustic rhinometry and nasal endoscopy were used to classify INVs before graft placement as narrow or normal and to assess changes at the INV after graft placement. Results: Mean pregraft MCA was 0.58 cm2. Mean MCA percent increase after graft placement was 22%. By INV type, percent increases were 51% for narrow INVs and 1% for normal INVs. Mean increases in MCA after graft placement were statistically significant for the entire group and for narrow INVs, with increases of 0.10 cm2 (p = 0.03) and 0.22 cm2 (p = 0.004), respectively. Conclusion: The upper lateral strut graft improved patency of cadaveric INVs, with statistically significant increases in the MCA most notable when placed for narrow INVs. [ABSTRACT FROM AUTHOR]

Background: Deviated nasal septum (DNS) is one of the major causes of nasal obstruction. Polyvinylidene fluoride (PVDF) nasal sensor is the new technique developed to assess the nasal obstruction caused by DNS. This study evaluates the PVDF nasal sensor measurements in comparison with PEAK nasal inspiratory flow (PNIF) measurements and visual analog scale (VAS) of nasal obstruction. Methods: Because of piezoelectric property, two PVDF nasal sensors provide output voltage signals corresponding to the right and left nostril when they are subjected to nasal airflow. The peak-to-peak amplitude of the voltage signal corresponding to nasal airflow was analyzed to assess the nasal obstruction. PVDF nasal sensor and PNIF were performed on 30 healthy subjects and 30 DNS patients. Receiver operating characteristic was used to analyze the DNS of these two methods. Results: Measurements of PVDF nasal sensor strongly correlated with findings of PNIF (r = 0.67; p < 0.01) in DNS patients. A significant difference (p < 0.001) was observed between PVDF nasal sensor measurements and PNIF measurements of the DNS and the control group. A cutoff between normal and pathological of 0.51 Vp-p for PVDF nasal sensor and 120 L/min for PNIF was calculated. No significant difference in terms of sensitivity of PVDF nasal sensor and PNIF (89.7% versus 82.6%) and specificity (80.5% versus 78.8%) was calculated. Conclusion: The result shows that PVDF measurements closely agree with PNIF findings. Developed PVDF nasal sensor is an objective method that is simple, inexpensive, fast, and portable for determining DNS in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Physical exercise causes a decrease in nasal mucosal congestion and hence an increase in nasal patency. This nasal response has been studied only in adults. A correlation between nasal obstruction and asthma or allergic rhinitis has been previously found. This study evaluates the influences of atopy and asthma on nasal patency and the changes in nasal patency induced by physical exercise in preschool children. Methods: An 8-minute exercise challenge test was conducted in 31 children aged between 4.1 and 6.4 years: 13 children had asthma, 17 were atopic, and 13 had neither asthma nor atopy. Nasal patency was measured with acoustic rhinometry at baseline and 10 minutes after the exercise. Results: At baseline, the total acoustic values were 17-25% larger in nonasthmatic children than in asthmatic children. Accordingly, the acoustic values in nonatopic children were 16-35% larger than in atopic children. After physical exercise, there was an overall increase in mean total nasal volume from 2.973 (SD = 0.647) to 3.405 cm3 (SD = 0.705), indicating an improvement of 15% in nasal volume (p = 0.025). The increase in nasal patency was similar in asthmatic and nonasthmatic children, as well as in atopic and nonatopic children. Conclusion: A significant increase in total nasal volume after physical exercise was found in all preschool children. The minimal cross-sectional areas remained smaller in asthmatic and atopic children after exercise, indicating partly irreversible nasal mucosal congestion in these children. [ABSTRACT FROM AUTHOR]

Background: Nasal provocation tests (NPTs) are useful for evaluation of patients with allergic rhinitis. The cold dry air (CDA) provocation test is useful for evaluation of patients with nonspecific nasal hyperreactivity (NHR). This study aimed to determine whether the NPT or CDA provocation would be more useful for patients with different clinical pictures. Methods: We evaluated changes in nasal symptoms (visual analog scale [VAS]) and acoustic parameters after NPT or CDA provocation in healthy volunteers (group A, n = 27), patients with allergic rhinitis (group B, n = 20), and subjects with nonallergic rhinitis (group C, n = 26). According to their subjective cold hyperresponsiveness (SCH), we compared changes in VAS and acoustic parameters after each protocol. The correlation between results of the skin-prick test (SPT) and changes in VAS after each protocol was analyzed. Finally, we performed an analysis of correlation between NPT and CDA provocation. Results: After NPT, group B showed a larger change in VAS for rhinorrhea, sneezing, and itching (p < 0.01). After CDA challenge, the change in VAS for nasal obstruction was larger in group C (p < 0.05). Changes in acoustic parameters were larger in groups B and C after NPT (p < 0.01). After CDA challenge, the SCH+ group (n = 49) showed a larger decrease of acoustic parameters than the SCH- group (n = 24; p < 0.01). Significant correlation was observed between the size of SPT and degree of change in VAS after NPT. No significant correlation was observed between NPT and CDA. Conclusion: CDA could be an adjunct tool for evaluating NHR in patients with self-reported SCH. [ABSTRACT FROM AUTHOR]

Background: Platelet-activating factor (PAF) is a lipid mediator produced by most inflammatory cells. Clinical and experimental findings suggest that PAF participates in allergic rhinitis (AR) pathogenesis. The aim was to assess the PAF ability to induce clinical response in nasal airway after local stimulation. Method: Ten nonatopic healthy volunteers (HVs) and 10 AR patients out of pollen season were enrolled. PAF increasing concentrations (100, 200, and 400 nM) were instilled into both nasal cavities (0, 30, and 60 minutes, respectively). Nasal symptoms (congestion, rhinorrhea, sneezing, itching, and total 4 symptom score and nasal volume between the 2nd and 5th cm (Vol2-5) using acoustic rhinometry (AcR), were assessed at -30, 0, 30, 60, 90, 120, and 240 minutes. Result: PAF increased individual and total nasal symptom score in both HVs and seasonal AR (SAR) patients from 30 to 120 minutes (maximum score at 120′, p < 0.05). Nasal obstruction was the most relevant and lasting nasal symptom. PAF also induced a significant reduction of Vol2-5 at 90′ (27%), 120′ (38.7%), and 240′ (36.4%). No differences in the response to PAF nasal challenge were observed between HVs and SAR subjects in either clinical symptoms or AcR. Conclusion: This is the first description of PAF effects on human nasal mucosa using a cumulative dose schedule and evaluated by both nasal symptoms and AcR. Nasal provocation with PAF showed long-lasting effects on nasal symptoms and nasal obstruction in HVs and in patients with SAR. Nasal challenge may be a useful tool to investigate the role of PAF in AR and the potential role of anti-PAF drugs. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) and associated congestion adversely affect patients' lives. The intranasal corticosteroid mometasone furoate nasal spray (MFNS) is effective for AR symptoms including nasal congestion, and the intranasal decongestant oxymetazoline (OXY) is effective against nasal congestion, but the combination has not been fully studied. This study was designed to assess the efficacy of the combination of MFNS and OXY for the relief of seasonal allergic rhinitis (SAR) symptoms. Methods: This phase 2 controlled clinical trial randomized adolescent and adult subjects (≥12 years; 2-year SAR) to MFNS q.d. (200 μg) + 3 sprays/nostril of OXY 0.05% (MFNS + OXY3); MFNS q.d. + 1 spray/nostril of OXY (MFNS + OXY1); MFNS q.d.; OXY b.i.d.; or placebo for 15 days, with 1-week follow-up. Coprimary end points were change from baseline in morning/evening (A.M./P.M.) instantaneous (NOW) total nasal symptom score (TNSS) over days 1-15 and AUC (AUC[0-4 hr]) change from baseline in day 1 congestion. Results: In 705 subjects, both combinations reduced A.M./P.M. NOW TNSS over days 1-15 significantly more than OXY b.i.d. or placebo (p ≤ 0.002). Mean standardized AUC(0-4 hr) day 1 congestion change from baseline was significantly greater in combination and OXY b.i.d. groups (MFNS + OXY3, -0.92; MFNS + OXY1, -0.80; OXY b.i.d., -1.06) versus placebo (-0.57) and MFNS q.d. (-0.63). Combinations and MFNS q.d. were significantly effective for A.M./P.M. NOW TNSS over each weekly period; OXY b.i.d. was superior to placebo in week 1. Adverse events (AEs) were few and similar across treatments; one MFNS q.d. and one placebo subject experienced a serious AE, with neither considered treatment related. Conclusion: Combining MFNS with OXY relieves SAR symptoms, including congestion, with faster onset of action than MFNS q.d. and better sustained efficacy than OXY b.i.d. [ABSTRACT FROM AUTHOR]

Background: Saline nasal irrigation (SNI) is often recommended as additional nonpharmacologic treatment, having proven its efficacy in acute and chronic rhinosinusitis and for therapy after sinonasal surgery. To date, however, no systematic review or meta-analysis exists showing the influence of SNI on allergic rhinitis (AR). This study aimed to establish the impact of SNI on symptoms of AR in different patient groups. Methods: We conducted a systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science databases for literature published from 1994 to 2010 on SNI in AR. Prospective, randomized, controlled trials that assessed the effects of SNI on four different outcome parameters were included. The evaluation focused on primary (symptom score) and secondary parameters (medicine consumption, mucociliary clearance, and quality of life). Results: Three independent reviewers chose 10 originals that satisfied the inclusion criteria (>400 participants total) from 50 relevant trials. SNI performed regularly over a limited period of up to 7 weeks was observed to have a positive effect on all investigated outcome parameters in adults and children with AR. SNI produced a 27.66% improvement in nasal symptoms, a 62.1% reduction in medicine consumption, a 31.19% acceleration of mucociliary clearance time, and a 27.88% improvement in quality of life. Conclusion: SNI using isotonic solution can be recommended as complementary therapy in AR. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient's health or causes unexpected side effects. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the nasal mucosa. This study was designed to investigate the role of nasal mucosa temperature in AR. Methods: We investigated the relationship between eosinophilic infiltration, nasal obstruction, and nasal mucosa temperature in 35 children with rhinitis aged 6-12 years. Results: A significant relationship was shown between nasal temperature values and eosinophil infiltration at nasal cytology (p < 0.01). Nasal temperature was also significantly associated with nasal obstruction, assessed in terms of nasal volume (Vol [2-5 cm]; p < 0.05) and minimum cross-sectional area (p < 0.01). No significant correlation emerged between the degree of nasal obstruction and presence of eosinophils at nasal cytology (p > 0.05). Conclusion: These results suggest a relationship between nasal temperature and nasal mucosa inflammation and obstruction. (ClinicalTrials.gov number: NCT00952835) [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction is a common symptom related to turbinate hypertrophy in 20% of cases. When medical treatment failed different surgical options were available. Actually, nasal physiology impairment after surgical treatment is not fully clear. This study evaluates microscopic mucosal changes and physiological function, by means of mucociliary transport time (MCT), after radiofrequency volume turbinate reduction and partial inferior turbinectomy. Methods: Forty-eight nonallergic patients were treated for chronic nasal obstruction. Twenty-six patients (group A) underwent radiofrequency turbinate reduction and 22 patients (group B) underwent partial turbinectomy associated with septoplasty. Mucosal specimens obtained before T0 and 6 months (T1) after surgery were compared by means of optical microscope and transmission electron microscope. All patients were evaluated using MCT at T0 and T1. Results: Optical analysis showed circumscribed squamous metaplasia and fibrosis in specimens obtained from group A. Same changes were more evident in group B. Ultrastructural analysis evidenced loss of ciliated epithelium in group B, whereas in group A a normal number of cilia was found. In all patients at T1, MCT time was prolonged in comparison with the preoperative values. After surgery, group B showed significantly prolonged MCT in comparison with group A (p < 0.05). Conclusion: In our study both surgical techniques achieved good clinical outcomes with improved nasal function, although the ciliated epithelium appeared partially impaired. These findings resulted in a prolonged MCT in all patients, especially in those treated with partial turbinectomy. Compared to partial resection, intraturbinal turbinate reduction seems to be the method of choice to better preserve nasal physiology. [ABSTRACT FROM AUTHOR]

Background: High dorsal deflection of the nasal septum around the bony-cartilaginous junction ('keystone area') is often missed and difficult to treat because of the importance of septal support. This study introduces a new technique of septoplasty to correct this dorsal deviation. Methods: Forty-two patients with severe dorsal septal deviation around the bony-cartilaginous junction were included in the study. The surgical process was as follows: after elevation of mucoperichondrial flap, deflected bony septum and surplus cartilage were removed. Then, partial thickness scorings were performed on the concave side of the deviated cartilaginous septum. For correcting the dorsal deviation around bony-cartilaginous junction, greenstick fracture and two suture holes were made at higher bony septum. Modified mattress suture was performed across the deflected bony-cartilaginous junction while pushing the deviated septum to the midline gently. Subjective and objective improvements were evaluated with questionnaires and acoustic rhinometry at least 3 months after the surgery. Results: Significant improvements in nasal obstruction (4.61-2.42) and discomfort (1.82-1.39) were achieved. On acoustic rhinometry, cross-sectional area (CSA1; 0.41 ± 0.18 to 0.64 ± 0.22 cm2) and CSA2 (0.83 ± 0.37 to 1.39 ± 0.36 cm2) at the narrower sides showed significant improvements and the ratio of the wider to narrower sides in CSA1 (2.61 ± 1.91 to 1.47 ± 0.61) and CSA2 (2.07 ± 1.51 to 1.33 ± 0.40) showed significant improvements. Conclusion: The proposed 'modified mattress suture technique' provides positive initial results for correction of the high dorsal deviation of septum around the bony-cartilaginous junction. [ABSTRACT FROM AUTHOR]

Background: There is still no study about the correlation between the symptom score and the reactivity to cold dry air (CDA). The authors developed a subjective cold hyperresponsiveness (SCH) scale for CDA and we evaluated its usefulness by comparing the changes of the symptom score and the acoustic parameters between different SCH groups and analyzing the correlation between the SCH scale and other parameters. Methods: One hundred fifty-two patients were classified according to their SCH scale. The symptom score by the visual analog scale (VAS), the total nasal volume (TNV), and the minimal cross-sectional area (MCA) by acoustic rhinometry were obtained before and after CDA provocation. Changes of these values were compared between groups and an analysis was performed for the correlation between SCH scale and change of the VAS, TNV, or MCA. Results: The patients with SCH grade 2 or 3 had a greater change of the VAS scores for nasal obstruction and rhinorrhea. The patients with SCH grade 2 or 3 had a greater change of the TNV (grade 0, 26.1 ± 17.2%; grade 1, 33.3 ± 26.5%, versus grade 2, 44.2 ± 30.0%; grade 3, 61.6 ± 40.0%; p < 0.05) and MCA (grade 0, 23.0 ± 25.3%; grade 1, 35.7 ± 51.1%, versus grade 2, 61.2 ± 72.4%; grade 3, 80.5 ± 56.4%; p < 0.05). Significant correlation existed between the SCH scale and changes in the TNV or MCA. Conclusion: We developed the SCH scale and proved its usefulness for evaluating nonspecific hyperreactivity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have described inferior turbinate hypertrophy compensatory to a septal deviation. The septal body contains vasoactive tissue that may behave in a manner similar to the inferior turbinate. The septal body, situated in the nasal valve region, may undergo changes that alter nasal anatomy and airflow patterns. The goal was to compare the size of the septal body to the laterality of septal deviation. The aim was to determine whether there is a correlation between the laterality of septal deviation and laterality of septal body prominence. Methods: Measurements were obtained from 100 sinus computerized tomography scans that were retrospectively reviewed. The degree of septal deviation, the size of the septal body, and the correlation between these measurements were assessed. Results: The mean septal body width was 9.3 mm. The degree of septal deviation was classified as mild in 27 cases, moderate in 36 cases, and severe in 27 cases. In 99 of 100 cases, the septal body was larger on the side opposite the nasal septal deviation, and this was statistically significant (p < 0.05). The difference in septal body thickness ipsilateral and contralateral to a septal deviation was found to correlate with the degree of septal deviation. Mean difference in septal body size was 3.98 mm in cases with severe septal deviation, 1.97 mm in cases with moderate deviation, and 1.21 mm in cases with mild septal deviation. Conclusion: The septal body is more prominent contralateral to a septal deviation. These findings are similar to those seen with inferior turbinate hypertrophy. The results indicate that septal body hypertrophy may play a role in regulating nasal airflow and may contribute to nasal obstruction. [ABSTRACT FROM AUTHOR]

Background: Acoustic rhinometry is more accurate in the anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), the most important site of nasal obstruction. Literature presents different opinions regarding the anatomical correlation of the two notches at the beginning of the rhinogram curve in normal adult white individuals. The aim of this study was to present new data for a better understanding of the anatomic correlation of these two notches. Methods: This prospective study included 32 nasal cavities under the following conditions: (1) basal condition, (2) with external nasal dilator strip (ENDS), (3) after decongestion (0.05% oxymetazoline chloride applied as an aerosol spray), and (4) after decongestion with ENDS. Results: No statistically significant variation was observed in the cross-sectional area of the first notch (CSA1) after decongestion. However, there was a statistically significant increase in the CSA2 after ENDS. Conclusion: Analysis of the results suggested that the first notch of the rhinogram refers to the nostril and the second notch refers to the NV as a whole. This study was part of the clinical trial NCT01411969 registered at www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: The goal of this study was to evaluate the effect of nasal surgery alone on sleep quality, architecture, position, and sleep-disordered breathing (SDB) (including obstructive apnea and snoring) in adult patients with obstructive sleep apnea syndrome (OSAS) and nasal obstruction. Methods: A total of 22 consecutive male patients (mean age, 41.3 ± 10.9 years) with OSAS and nasal obstruction, who underwent nasal surgery alone, were enrolled in the study. We compared polysomnographic data related with sleep quality (sleep efficiency [SE] and arousal index [ArI]), sleep architecture (stages N [nonrapid eye movement], 1, 2, and 3, and R [rapid eye movement]), the distribution of sleep positions, and SDB (apnea-hypopnea index [AHI], apnea index [AI], minimum arterial oxygen saturation [SaO2], and snoring) before and after nasal surgery. Results: SE (from 86.6 ± 6.3% to 89.7 ± 7.1%; p = 0.039), stage R (from 15.3 ± 4.8% to 18.6 ± 5.4%; p = 0.016) and snoring (from 32.2 ± 16.4% to 25.8 ± 18.6%; p = 0.045) significantly changed after nasal surgery. However, there were no significant changes in ArI, other sleep stages, the proportion of sleep time spent in the supine position, AHI, AI, and minimum SaO2 after nasal surgery. Conclusion: Nasal surgery alone was partially effective in improving sleep quality, architecture, and snoring, but it had no effect on the change of the distribution of sleep positions and obstructive apnea in patients with OSAS and nasal obstruction. [ABSTRACT FROM AUTHOR]

Background: This study evaluated surgical outcomes after endonasal septoplasty using caudal septal batten grafting for caudal septal deviation. Methods: Fifty-six patients completed questionnaires to assess nasal obstruction by telephone interviews 8-63 months postoperatively (12.2 months on the average). In addition, patients assessed the severity of nasal symptoms (i.e., mouth breathing, mouth dryness, hyposmia, rhinorrhea, epistaxis, trouble sleeping, snoring, and being concerned about nasal problems) preoperatively and postoperatively using a visual analog scale (VAS). These VAS scores were compared with those of patients who underwent endonasal septoplasty using the cutting and suture technique. Complications were analyzed. Results: Thirty-four (60.7%) patients reported their nasal obstruction was much improved, 17 (30.3%) reported their condition was improved, and 5 (8.9%) reported no change postoperatively. Patients reported a decrease in severity of all nasal symptoms (p < 0.05 for each). Their nasal obstruction improvement was not significantly different from that of patients managed by the cutting and suture technique. Complications after surgery included hyposmia in two cases, small septal perforation in one case, chondritis in one case, and septal abscess in one case, and all were managed successfully. No patient required revision septoplasty due to recurrence during the follow-up period. Conclusion: Endonasal septoplasty using caudal septal batten grafting for caudal septal deviation resulted in improvement in nasal obstruction and nasal symptoms and was associated with an acceptable complication rate. [ABSTRACT FROM AUTHOR]

Background: Noninvasive evaluation of nasal airflow has remained a constant challenge for clinicians. A recently developed method for measurement of nasal obstruction has been evaluated. This study was designed to compare results of nasal sound spectral analysis (NSSA) with results of peak nasal inspiratory flow (PNIF) and visual analog scale (VAS) of nasal obstruction. Main outcome measure was diagnostic accuracy evaluation of NSSA compared with PNIF in nasal septal deviation. Methods: Analysis of original nasal sounds was performed using the ameliorated NSSA system with a software program and evaluation of nasal inspiratory sound and its intensity into spectral and frequency scale was performed using fast Fourier transform. NSSA and PNIF were performed on 43 patients with nasal septal deviations and 40 healthy subjects. We characterized the following frequency spectrum using a series of variables: low frequency (0-1 kHz), medium frequency (1-2 kHz), and high frequency (2-4 kHz). Results: A significant difference was observed between PNIF values and nasal inspiratory sound intensity of the deviated patients and the control group (p < 0.001). A correlation was observed in patients between NSSA results at a frequency range of 2-4 kHz and PNIF results. A cutoff between normal and pathological of 15.2 ± 2.0 dB (2-4 kHz) for NSSA and 118.0 ± 15.5 L/min for PNIF was calculated. No significant differences in terms of sensitivity of NSSA and PNIF (86.04% versus 79.07%) and specificity (82.50% versus 77.50%) were computed. Conclusion: NSSA and PNIF provide valuable information to aid in support of clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction is one of the most frequent symptoms in the ear, nose, and throat (ENT) setting. It can be evaluated either subjectively or objectively. In a subjective way, a visual analog scale (VAS) and the Sino-Nasal Outcome Test 20 (SNOT 20) can rapidly quantify the degree of obstruction, whereas the most commonly used objective methods are nasal endoscopy and active anterior rhinomanometry (AAR). It is still a matter of controversy to what extent the sense of nasal obstruction is associated with objective measures for nasal space and airflow. The aim of the study was to evaluate nasal breathing before and after functional nasal surgery by video-rhino-hygrometer (VRH) comparing the results with widely accepted methods. Methods: Twenty patient candidates for septoplasty and inferior turbinate reduction were included in the study. SNOT-20, VAS, nasal endoscopy, and AAR were analyzed and compared with VRH values. Results: Before surgery VRH showed variability of nasal respiratory flow between individuals and between nostrils. After surgery we had an increase (p < 0.05) of airflow in both nostrils. VRH data were found to be correlated with VAS and SNOT-20 values (p < 0.05) both pre- and postoperatively. Despite the statistically significant correlation of AAR with SNOT-20 and VAS, no statistically significant correlation between AAR and VRH was found. Conclusion: VRH provides an immediate, easy, and noninvasive assessment of nasal respiration. For these reasons it can be used, in association with rhinoscopic data and other instrumental tests, to evaluate nasal breathing in daily ENT practice. [ABSTRACT FROM AUTHOR]

Background: The aim of this clinical investigation was to determine the outcomes of an outpatient videoendoscopic diode laser polypectomy (DLPE) and subsequent topical high-dose corticosteroid application in chronic rhinosinusitis with recurrent nasal polyposis (NP). Methods: After ineffective revision sinus surgery and prolonged mometasone furoate application, 19 consecutive mild and moderate NP patients suffering from nasal obstruction (NO) and olfactory dysfunction (OD) were prospectively entered into the study to undergo DLPE under topical anesthesia. Beginning 1 week postoperatively, 250 μg of beclomethasone dipropionate aerosol spray (BDPAS) was self-administered into each nostril twice a day. Treatment efficacy was assessed after 1, 6, and 12 weeks and at quarterly long-term follow-ups based on objective parameters (videoendoscopic photodocumentation and rhinomanometry) and subjective evaluation of NO, OD, and satisfaction (visual analog scales [VASs]). Results: VASs indicated very low values for intraoperative pain and discomfort and high postoperative satisfaction. After 6 weeks, subjective and objective data revealed a significant improvement of NO and OD (p < 0.0005). Topical BDPAS application was well tolerated. At a median follow-up of 32 months (range, 1-4 years), 21% of the patients developed NP disappearance, 53% had a stable disease, and 26% had a progressive disease. Conclusion: In therapy-refractory NP, endonasal DLPE represents a minimally invasive, symptom-oriented, safe and easily reapplicable outpatient treatment option that provides effective improvement of NO and OD. Compared with the pre-DLPE period, the proposed long-term quarterly follow-up combined with high-dose topical BDPAS application might reduce or delay the need for major surgery and appears to be suitable for disease control. [ABSTRACT FROM AUTHOR]

Background: The role of increased nasal resistance in obstructive sleep apnea syndrome (OSAS) remains controversial. The aim of this study was to examine the pathogenetic role of nasal obstruction in obese patients with OSAS. Methods: Patients with OSAS (n = 125) at a university hospital were divided into three groups according to body mass index (BMI): nonobese (BMI < 25 kg/m2), mildly obese (25 kg/m2 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The subjects underwent nasopharyngoscopy, measurement of nasal resistance, and polysomnography. Results: We studied 42 nonobese, 47 mildly obese, and 36 obese patients with OSAS. Among the obese, but not the nonobese and mildly obese patients, we found significant correlations between the oxygen desaturation index (ODI) and bilateral nasal resistance (BNR; r = 0.412; p = 0.013), between the ODI and unilateral higher nasal resistance (UHNR; r = 0.413; p = 0.012), and between the apnea index and UHNR (r = 0.334; p = 0.046). Multiple regression analysis incorporating all patients showed that BMI (p < 0.001) and BNR (p = 0.033) were independently related to the ODI. Conclusion: In obese patients with OSAS, increased nasal resistance could play an important pathogenetic role in hypoxemic apnea. [ABSTRACT FROM AUTHOR]