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Background: Nasal obstruction in humans leads to mouth breathing and subsequent hypoxia in the entire body. Furthermore, nasal obstruction in growing children affects craniofacial growth and development. Objective: To investigate the effects of unilateral nasal obstruction (UNO) on craniofacial growth in mice of different ages, particularly on the morphology of the nasomaxillary complex and mandible. Methods: Mice aged 3, 6 and 12 weeks were selected as representatives of juvenile, adolescent and adult stages, respectively. A total of 30 male C57BL/6J mice (10 mice each at the ages of 3, 6 and 12 weeks) were used in this study for a 3‐week experiment. The mice in each age stage were randomly and evenly assigned to either the control group (C3+3, C6+3 and C12+3) or the experimental group (E3+3, E6+3 and E12+3). The UNO model in experimental group was constructed by plugging the mouse's left nostril, thereby disrupting its normal nasal breathing pattern and inducing hypoxia. The control group underwent the sham procedure. After 3 weeks, the length, width and height of the cranium, nasomaxillary complex and mandible of each group were measured on two‐dimensional images constructed by micro‐computed tomography. Furthermore, the impact of UNO on mouse growth was evaluated through the measurement of femoral length. Results: In juvenile mice, UNO inhibited the growth of cranial width, cranial height and mandibular length. In adolescent mice, UNO impeded the growth of the femoral length, cranial length, nasomaxillary length and mandibular length. In adult mice, no significant negative effects of UNO on craniofacial growth were found. Conclusion: Referring to the experimental results, in addition to actively treating nasal obstruction in patients, it is important to monitor the growth of the mandible in juveniles, as well as the nasomaxillary and mandibular growth in adolescents during orthodontic clinical practice. [ABSTRACT FROM AUTHOR]

Nasal obstruction leads to a hypoxia condition throughout the entire body. In this study, the unilateral nasal obstruction (UNO) mouse model was established by blocking the left nostril of mice. The aim of this study was to investigate the effects of UNO‐induced hypoxia on mandibular condyle in juvenile (3‐week‐old), adolescent (6‐week‐old) and adult (12‐week‐old) male C57BL/6J mice from the perspective of H‐type angiogenesis coupling osteogenesis. Firstly, UNO exerted a significant inhibitory effect on weight gain in mice of all ages. However, only in adolescent mice did UNO have an obvious detrimental effect on femoral bone mass accrual. Subsequently, micro‐computed tomography (CT) analysis of mandibular condylar bone mass revealed that UNO significantly retarded condylar head volume gain but increased condylar head trabecular number (Tb.N) in juvenile and adolescent mice. Furthermore, UNO promoted the ratio of proliferative layer to cartilage layer in condylar cartilage and facilitated the chondrocyte‐to‐osteoblast transformation in juvenile and adolescent mice. Moreover, although UNO enhanced the positive expression of hypoxia‐inducible factor (HIF)‐1α in the condylar subchondral bone of mice in all ages, an increase in H‐type vessels and Osterix+ cells was only detected in juvenile and adolescent mice. In summary, on the one hand, in terms of condylar morphology, UNO has a negative effect on condylar growth, hindering the increase in condylar head volume in juvenile and adolescent mice. However, on the other hand, in terms of condylar microstructure, UNO has a positive effect on condylar osteogenesis, promoting the increase of condylar Tb.N, chondrocyte‐to‐osteoblast transformation, HIF‐1α expression, H‐type angiogenesis and Osterix+ cells in juvenile and adolescent mice. Although the changes in condylar morphology and microstructure caused by UNO have not yet been fully elucidated, these findings improve our current understanding of the effects of UNO on condylar bone homeostasis. [ABSTRACT FROM AUTHOR]

Nasopharyngeal cysts are rare benign entity, smaller in size and usually asymptomatic. They are mostly diagnosed incidentally on MRI. Larger cysts commonly presents with spasmodic and obstructive symptoms. Thornwaldt cysts are congenital cysts originating from the mid- line of the nasopharynx just above the upper border of the superior constrictor muscle. They represent primitive communication between notochord remnants and the pharyngeal endoderm. We report this case because of its unique presentation in a 35 year old male. Patient presented with nasal blockage, nasal discharge, snoring, ear pain and aural fullness, intermittent neck pain and neck stiffness. Preoperative evaluation included diagnostic nasal endoscopy (DNE) and Magnetic resonance imaging (MRI-scan). A large cystic mass of size 2.8 cm × 3 cm was diagnosed on DNE and MRI. Transnasal Marsupialisation and excision of the cyst was planned using powered instruments. Post operatively, patient noticed marked improvement in the obstructive symptoms. Regular follow up was done 6 monthly for 2 years. No recurrence was noted on DNE. Although a rare pathology in adulthood, it should be kept as a differential diagnosis for cervical pain and neck stiffness. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Despite the high levels of success after orthognathic surgery, the immediate postoperative pain and edema, besides the neurosensorial deficits, are common complications.This study aimed to evaluate the pattern of sensory and inflammatory responses in patients undergoing orthognathic surgery.This prospective observational study included 20 patients undergoing bimaxillary orthognathic surgery, who were evaluated in the preoperative period and on Days 1, 2, 3, 4, 5, 6, 7, and 30 after surgery, using a battery of tests to assess sensorial and inflammatory changes.Subjective and objective evaluations of edema indicated a trend toward edema resolution within 30 days, with a significant decrease in mouth opening on days 1, 7, and 30 after surgery. Regarding nasal obstruction, a significant increase in Nasal Obstruction Symptom Evaluation (NOSE) scores was demonstrated on the first, second, and third days, returning to preoperative levels after 30 days. There was a significant increase in visual analogic scale (VAS) scores from the first to the seventh day after surgery, with a reduction within 30 days. For mechanical and thermal sensitivity tests, the lower lip and chin regions had poorer results, without recovery after 30 days. Positive correlations were observed between painful and inflammatory parameters, as well as between subjective and objective evaluations. Analysis of saliva biomarkers did not show significant differences for pre‐ and postoperative CCL3 or CCL4 levels.Data provide new evidence about the early inflammatory and sensorial complications after orthognathic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction. Methods: Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale. Results: A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34. Conclusion: Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted. [ABSTRACT FROM AUTHOR]

The era of value-based health care is characterized by an increasing interest in patient-reported health outcomes. For this purpose we developed the rhinoplasty health care monitor (RHM), a streamlined outcome measurement protocol, including all rhinoplasty patients since 2014. Statistical analyses of patient-reported outcome data are automated and visually presented on a custom web-based dashboard. We describe the clinical and practical benefits of the RHM and discuss how routine prospective outcome measurements have upgraded our care standards. For this prospective study, 979 consecutive patients referred for functional (revision) rhinoplasty from April 2014 to August 2023 were included. Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (NOSE), Utrecht Questionnaire (UQ), and visual analog scales (VAS) were obtained. Of 979 referred patients, 599 (61.2%) were eligible for rhinoplasty. One year postoperatively, mean NOSE scale sum score improved from 69.1 ± 22.8 to 23.1 ± 23.5 (p < 0.001). Functional VAS scores improved from 4.1 ± 2.8 (left) and 4.1 ± 2.8 (right) to 7.5 ± 1.9 (left) and 7.3 ± 2.0 (right; p < 0.001). Mean UQ sum score improved from 12.0 ± 6.4 to 6.8 ± 3.3 and aesthetic VAS score improved from 4.5 ± 2.5 to 7.4 ± 1.7 (p < 0.001) 1 year postoperatively. Benefits of the outcome routine were improved patient selection, data-driven expectation management and patient empowerment, and targeted critical appraisals of surgical performance. In conclusion, routine, automated, prospective outcome monitoring provides physicians with a response to the increasing demand for data-driven insights in health outcomes. The limited effort that is needed to gather and monitor outcome data is heavily repaid by valuable insights into aspects of care that can be improved. [ABSTRACT FROM AUTHOR]

Background: Studies have found that in healthy individuals without nasal disease, changes in posture cause an increase in nasal resistance, especially in the prone posture. Many patients with obstructive sleep apnea syndrome (OSAS) sleep in a prone posture, but no studies have examined the effect of this change in posture on nasal resistance in patients with OSAS. Therefore, we conducted this study to investigate this posture-related physical phenomenon in individuals with OSAS. Methods: We evaluated the nasal patency of 29 patients diagnosed with OSAS using the visual analog scale (VAS), acoustic rhinometry, and video-endoscopy in the sitting, supine, and prone postures. Results: In the OSAS group, both supine and prone postures significantly influenced subjective nasal blockage and led to a notable reduction in the minimal cross-sectional area (mCSA) as determined by acoustic rhinometry, compared to the sitting posture. The prone posture exhibited a more pronounced effect than the supine posture. Endoscopic evaluations further revealed increased hypertrophy of the inferior turbinate in the supine posture for the right nasal passage and the prone posture for the left. However, no significant differences were observed between the prone and supine postures. Conclusion: In OSAS patients, nasal resistance significantly increased in supine and prone postures compared to sitting, with the prone posture showing a greater effect. Clinicians should consider a patient's habitual sleep posture and the effects of postural changes when assessing OSAS severity and devising treatment plans. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of chronic rhinosinusitis (CRS) in patients presenting with the chief complaint of nasal allergies. Study Design: Cross‐sectional study. Setting: Tertiary care, academic center. Methods: Clinical and demographic characteristics were collected from participants who were patients presenting with the chief complaint of nasal allergies. From all participants, a 22‐item Sinonasal Outcome Test (SNOT‐22) was collected, and a modified Lund‐Kennedy endoscopy score was calculated from nasal endoscopy. Association was sought between having CRS and variables of clinical and demographic characteristics, SNOT‐22, and endoscopy score. Results: A total of 219 patients were recruited and 91.3% were diagnosed with allergic rhinitis; 45.2% were also diagnosed with CRS. Approximately half of the patients with CRS reported no intranasal corticosteroid usage. Having CRS was associated with male sex (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.30‐4.04, P =.004), endoscopy score (OR = 1.96, 95% CI: 1.59‐2.42, P <.001), and the SNOT‐22 nasal subdomain score (OR = 1.07, 95% CI: 1.03‐1.11, P =.001) related to SNOT‐22 items: "need to blow nose," "thick nasal discharge," "sense of taste/smell," and "blockage/congestion of nose." At least moderate (item score ≥3) "blockage/congestion of nose" or "thick nasal discharge," mild "need to blow nose" (item score ≥2) or very mild decreased "sense of taste/smell" (item score ≥1), and any nasal endoscopy findings (endoscopy score ≥1) were statistically significant predictors of CRS. Conclusion: Moderate or more severe nasal obstruction or discharge symptoms, any decreased sense of smell/taste, or positive nasal endoscopy findings in patients believing they have allergic rhinitis should prompt further evaluation of CRS to avoid delays in treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Studies have found that in healthy individuals without nasal disease, changes in posture cause an increase in nasal resistance, especially in the prone posture. Many patients with obstructive sleep apnea syndrome (OSAS) sleep in a prone posture, but no studies have examined the effect of this change in posture on nasal resistance in patients with OSAS. Therefore, we conducted this study to investigate this posture-related physical phenomenon in individuals with OSAS. Methods We evaluated the nasal patency of 29 patients diagnosed with OSAS using the visual analog scale (VAS), acoustic rhinometry, and video-endoscopy in the sitting, supine, and prone postures. Results In the OSAS group, both supine and prone postures significantly influenced subjective nasal blockage and led to a notable reduction in the minimal cross-sectional area (mCSA) as determined by acoustic rhinometry, compared to the sitting posture. The prone posture exhibited a more pronounced effect than the supine posture. Endoscopic evaluations further revealed increased hypertrophy of the inferior turbinate in the supine posture for the right nasal passage and the prone posture for the left. However, no significant differences were observed between the prone and supine postures. Conclusion In OSAS patients, nasal resistance significantly increased in supine and prone postures compared to sitting, with the prone posture showing a greater effect. Clinicians should consider a patient’s habitual sleep posture and the effects of postural changes when assessing OSAS severity and devising treatment plans. Level of Evidence 4.

Nasal valve dysfunction can substantially impact nasal airflow and overall quality of life. This review provides a comprehensive examination of nasal valve dysfunction, including its mechanisms, classification, and surgical management. The nasal valves include internal and external valves, each of which plays a crucial role in regulating nasal airflow. Subclassification of the external nasal valve into alar and rim valves helps specify the site of obstruction when present and informs the choice of surgical intervention. Dynamic nasal valve obstruction, often characterized by inspiratory collapse of the nasal valve, must be distinguished from static obstruction, which refers to nasal valve stenosis. Accurate identification of the location and mechanism of nasal valve dysfunction is essential for effective management. Various surgical procedures target specific components of the nasal valve and can produce favorable functional outcomes. The selection of surgical procedures, whether individually or in combination, should be tailored to the characteristics of nasal valve dysfunction and the external nasal characteristics of the patient. Strict adherence to proper surgical techniques is imperative for achieving optimal treatment outcomes.

Objectives. Nasal valve surgery for internal nasal valve (INV) compromise has become increasingly popular. However, this rise in popularity has sparked debates regarding its indications and disputes over insurance coverage, primarily due to the lack of a gold-standard evaluation method. Therefore, we aimed to identify objective parameters for the INV compromise. Methods. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data comprised facial computed tomography (CT) images, acoustic rhinometry, the modified Cottle test, and symptom scores. Patients were categorized based on their symptoms and the results of the modified Cottle test. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using CT. Results. The compromised INV group, characterized by nasal obstruction with a positive modified Cottle test, exhibited smaller INV areas in both coronal and axial views, reduced INV volume in the axial view, and a thinner lateral wall in the coronal view (all P

Background: Nasal congestion in allergic rhinitis (AR) is caused by vascular hyperpermeability and vascular relaxation of the nasal mucosa. We previously detected high levels of a lipoxygenation metabolite of dihomogammalinolenic acid, 15-hydroxy-8Z,11Z,13E-eicosatrienoic acid (15-HETrE) in the nasal lavage fluid of AR model mice. Here, we investigated the effects of 15-HETrE on vascular functions associated with nasal congestion. Methods: We measured 15-HETrE levels in the nasal lavage fluid of ovalbumin-induced AR model mice and nasal discharge of patients with AR. We also assessed nasal congestion and vascular relaxation in mice. Vascular contractility was investigated using isolated mouse aortas. Results: Five ovalbumin challenges increased 15-HETrE levels in AR model mice. 15-HETrE was also detected in patients who exhibiting AR-related symptoms. Intranasal administration of 15-HETrE elicited dyspnea-related behavior and decreased the nasal cavity volume in mice. Miles assay and whole-mount immunostaining revealed that 15-HETrE administration caused vascular hyperpermeability and relaxation of the nasal mucosa. Intravital imaging demonstrated that 15-HETrE relaxed the ear vessels that were precontracted via thromboxane receptor stimulation. Moreover, 15-HETrE dilated the isolated mouse aortas, and this effect was attenuated by K+ channel inhibitors and prostaglandin D2 (DP) and prostacyclin (IP) receptor antagonists. Additionally, vasodilatory effects of 15-HETrE were accompanied by an increase in intracellular cAMP levels. Conclusions: Our results indicate that 15-HETrE, whose levels are elevated in the nasal cavity upon AR, can be a novel lipid mediator that exacerbates nasal congestion. Moreover, it can stimulate DP and IP receptors and downstream K+ channels to dilate the nasal mucosal vasculature.

Background: Nasal obstruction is a frequent problem amongst patients with sleep-disordered breathing (SDB). Radiofrequency of the inferior turbinates (RFIT) is commonly utilized for inferior turbinate (IT) reduction but its effectiveness in SDB patients remains unproven. We aim to evaluate long-term objective and subjective nasal, olfactory and sleep outcomes following RFIT in SDB patients. Methods: Patients were assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 12 months (T3) following RFIT. At T0, T1, T2 and T3, the patients underwent objective assessments of their nasal airways and smell function and an evaluation of their quality-of-life, sinonasal, olfactory and sleep symptoms. Sleep studies were carried out at T0 and T2. Results: Seventeen patients (with a median age of 42 years) underwent RFIT. A statistically significant objective and subjective improvement of the patients' nasal airways was demonstrated at T1. No other statistically significant changes were observed in the patients' nasal airways, smell, sleep study parameters or patient-reported outcomes at the other follow-ups. A multivariate analysis confirmed a statistically significant influence of age (older), sex (male), a higher BMI, the presence of septal deviation and the presence of allergic rhinitis in some of the studies' parameters. A statistically significant objective and subjective improvement of the patients' nasal airways was confirmed in the fitted model when considering the influence of the available variables. Conclusions: Our study confirms that the benefits of RFIT alone in SDB patients are limited and possibly only in the short-term period. Patient-related variables can potentially influence the final outcomes. [ABSTRACT FROM AUTHOR]

Tumors in the nasal septum originating from salivary glands are uncommon, and among them, pleomorphic adenomas represent a distinctive manifestation.This case study explores a female in her early thirties with a right-sided nasal mass, nasal obstruction, and intermittent bleeding. CT imaging revealed a lesion arising from the nasal septum with bony erosion. Histopathology confirmed pleomorphic adenoma,emphasizing the importance of thorough clinical evaluation, imaging, and biopsy for accurate diagnosis. Pleomorphic adenomas, typically found in major salivary glands, can occur in the respiratory tract, presenting challenges in distinguishing them from malignant tumors. Treatment involves wide local resection, and postoperative recurrence may necessitate radiotherapy. While intranasal pleomorphic adenomas generally have a favorable prognosis, those arising from the nasal septum have an elevated likelihood of malignancy. Vigilant monitoring is crucial due to the potential for recurrence, malignant transformation, and metastasis. [ABSTRACT FROM AUTHOR]

Purpose: Nasal valve insufficiency is known to have a negative impact on both nasal patency and quality of life. The titanium butterfly implant is a surgical treatment proven to have a positive effect on these aspects up to 6 months postoperative. This study aimed to determine the long-term effects of the titanium butterfly implant on nasal obstruction symptoms and quality of life in adult patients with nasal valve insufficiency up to 5 years after procedure. Methods: A prospective single cohort study was performed including 29 patients that underwent the titanium butterfly implant in one tertiary medical center. Data was obtained before and at least 5 years after surgery using three questionnaires: the Nasal Obstruction and Septoplasty Effectiveness questionnaire, the Sino-Nasal Outcome Test 22 and the Glasgow Benefit Inventory questionnaire. Results: A significant decrease in total NOSE score was seen compared to baseline measurements. The SNOT-22 scores also showed a significant decrease, whereas the GBI scores showed no significant changes at the late follow-up. Conclusion: Seven years after placement the titanium butterfly implant still has a statistically significant improvement on otorhinologic-related quality of life compared to preoperative measurements. [ABSTRACT FROM AUTHOR]

The goal of this American Rhinologic Society Expert Practice Statement (EPS) is to provide recommendations and guidance through evidence‐based consensus statements regarding pediatric septoplasty. This EPS was developed following the previously published methodology and approval process. The topics of interest included appropriate indications, safety and efficacy, timing, relevant quality of life instruments, and surgical techniques. Following a modified Delphi approach, six statements were developed, five of which reached consensus and one that did not. These statements and accompanying evidence are summarized along with an assessment of future needs. [ABSTRACT FROM AUTHOR]

Background: The Nasal Obstruction Symptom Evaluation (NOSE) is a questionnaire to assess patients with nasal obstruction. The aim of this study was to translate and validate NOSE to the Malay version NOSE (M-NOSE). Methods: The NOSE questionnaire was translated to Malay language and back to English. Psychometric properties consisting of reliability, reproducibility, validity, responsiveness were appraised in patients with nasal obstruction due to deviated nasal septum and healthy asymptomatic controls. Results: A total of 126 participants were recruited. There was significant difference between patients and controls for all items and the total score (all p < 0.001). The correlation was moderate to strong between all items and total score (r = 0.71 to 0.8) and fair to moderate for the inter-items correlations (r= 0.31 to 0.70). Internal consistency for M-NOSE was good (α = 0.81). The test–retest for each item demonstrated no significant difference. There was significant difference of the pre- and post-operative mean for each item and total score (all p < 0.001) with good response sensitivity (effect size, d = 4.91). Conclusions: The M-NOSE has satisfactory reliability, internal consistency, reproducibility and responsiveness. It is a valid and convenient tool in the assessment of the impact and treatment outcome of nasal obstruction. [ABSTRACT FROM AUTHOR]

Nasal congestion in allergic rhinitis (AR) is caused by vascular hyperpermeability and vascular relaxation of the nasal mucosa. We previously detected high levels of a lipoxygenation metabolite of dihomogammalinolenic acid, 15-hydroxy-8Z,11Z,13E-eicosatrienoic acid (15-HETrE) in the nasal lavage fluid of AR model mice. Here, we investigated the effects of 15-HETrE on vascular functions associated with nasal congestion. We measured 15-HETrE levels in the nasal lavage fluid of ovalbumin-induced AR model mice and nasal discharge of patients with AR. We also assessed nasal congestion and vascular relaxation in mice. Vascular contractility was investigated using isolated mouse aortas. Five ovalbumin challenges increased 15-HETrE levels in AR model mice. 15-HETrE was also detected in patients who exhibiting AR-related symptoms. Intranasal administration of 15-HETrE elicited dyspnea-related behavior and decreased the nasal cavity volume in mice. Miles assay and whole-mount immunostaining revealed that 15-HETrE administration caused vascular hyperpermeability and relaxation of the nasal mucosa. Intravital imaging demonstrated that 15-HETrE relaxed the ear vessels that were precontracted via thromboxane receptor stimulation. Moreover, 15-HETrE dilated the isolated mouse aortas, and this effect was attenuated by K+ channel inhibitors and prostaglandin D 2 (DP) and prostacyclin (IP) receptor antagonists. Additionally, vasodilatory effects of 15-HETrE were accompanied by an increase in intracellular cAMP levels. Our results indicate that 15-HETrE, whose levels are elevated in the nasal cavity upon AR, can be a novel lipid mediator that exacerbates nasal congestion. Moreover, it can stimulate DP and IP receptors and downstream K+ channels to dilate the nasal mucosal vasculature. [ABSTRACT FROM AUTHOR]

Introduction: Rhinoseptoplasty procedures are focused not only on the aesthetic but also on the functional aspects. Surgical outcomes have to be evaluated in each patient. To date, the Polish literature has lacked a tool facilitating simultaneous assessment of rhinoseptoplasty's impact on both the external appearance and functionality of the nose. Aim: The aim of this study was to translate, adapt, and validate the Polish version of the original SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) questionnaire as used for the assessment of the functional and aesthetic outcomes in patients after rhinoplasty. Materials and methods: A total of 31 subjects (N = 24 [77.4%] women and N = 7 men [22.6%]) aged 19 through 55 years (M = 31.32; SD = 8.50) participated in the study. The SCHNOS questionnaire was translated in accordance with international guidelines. The psychometric accuracy of translation was tested in native speakers of Polish. The authors measured the internal consistency, correlatability, and repeatability of the instrument to determine its validity. The data were subjected to statistical analysis. Results: The confirmatory factor analysis confirmed the two-factor structure of the scale. The satisfactory reliability amounted to 0.888 [95% CI: 0.804--0.940] for the SCHNOS-O and 0.883 [95% CI 0.795--0.937] for the SCHNOS-C scale. Differential accuracy was confirmed by AVE values of > 0.5 as well as by correlation of the results with the Rhinoplasty Outcome Evaluation (ROE) questionnaire scores. Conclusions: The SCHNOS questionnaire has been translated, adapted, and validated for use in the Polish-speaking population. The tool was found to be relevant and reliable. [ABSTRACT FROM AUTHOR]

Choanal atresia is defined as the complete obstruction of the posterior nasal airway. The obstruction is the origin of maxillary impairment in the development. We describe a case of a man with unilateral choanal atresia who was referred to the maxilla-facial surgery department for his maxillary anomalies. The patient suffered from hypoplasia of the midface with class III malocclusion. and retromaxillia. He had also solitary median maxillary central incisor syndrome (SMMCI). Choanal atresia leads to nasal obstruction resulting in mouth breathing. The maxillary consequences are long face, contraction of the upper dental arch and high arched palate. The patients present class III malocclusion with posterior cross bite, anterior open bite. SMMCI may also be present. The maxillary anomalies would be only slightly due to the presence of chronic nasal obstruction. The mouth breathing, which results from the nasal obstruction, is an etiological factor at the origin of maxillary anomalies. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. Methodology/Principal: A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT—with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. Results: A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P =.048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P =.002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (−13.9 ± 110.3 L/minute vs −3.4 ± 78.1 L/minute, P =.049) and NAR (−0.120 ± 0.342 Pa/cm³/second vs −0.093 ± 0.224 Pa/cm³/second, P =.050). Conclusions: Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone. [ABSTRACT FROM AUTHOR]

Chondro-osseous respiratory adenomatoid hamartoma (COREAH) are extremely rare benign lesions of the sinonasal tract. It is present in 3 to 83-year-olds. It originates from various sites of the sinonasal tract; the most common site is the posterior lateral wall of the nasal cavity. Imaging calcification is an important finding in COREAH. In this case report, we present an exceptionally rare occurrence involving a 55-year-old female patient who exhibited symptoms of nasal obstruction, bleeding from the left side of the nasal cavity and loss of smell. We aim to share our experience in managing this unique condition. Diagnostic nasal endoscopic examination of the patient revealed a reddish, fleshy polypoidal mass in the left nasal cavity arising from the lateral wall of the left nasal cavity posteriorly and extending anteriorly into the left nasal cavity. The patient underwent an excisional biopsy. Upon microscopic examination, we observed a hamartomatous proliferation of respiratory-type glands exhibiting mucinous metaplasia. Additionally, numerous spicules of mature bone were present, a distinctive feature of COREAH. The patient underwent a 6-month follow-up, during which no recurrent growth was detected within the nasal cavity. [ABSTRACT FROM AUTHOR]

Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery. [ABSTRACT FROM AUTHOR]

Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post-nasal septal surgery in the pediatric population. In addition, there is evidence to suggest that failure to treat nasal obstruction in children may itself result in facial deformity and/or developmental delay. The aim of this systematic review is to evaluate the efficacy and safety of septal surgery in pediatric patients with nasal obstruction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched. Original studies in pediatric patients (<18 years of age) with nasal obstruction were eligible for inclusion. Patients with cleft lip or palate as their primary diagnosis were excluded. Our primary outcomes were patient-reported outcome measures (PROMs), postsurgical complications, and revision rates. Secondary outcomes included surgical technique, anatomical considerations, and anthropometric measurements. Eighteen studies were included (1,080 patients). Patients underwent septoplasty, septorhinoplasty, rhinoplasty, or a combination of procedures for nasal obstruction. Obstruction was commonly reported secondary to trauma, nasal septal deviation, or congenital deformity. The mean age of the patients was 13.04 years with an average follow-up of 41.8 months. In all, 5.6% patients required revision surgery and there was an overall complication rate of 7.8%. Septal surgery for nasal obstruction in children has low revision and complication rates. However, a pediatric-specific outcome measure is yet to be determined. Larger prospective studies with long-term follow-up periods are needed to determine the optimal timing of nasal surgery for nasal obstruction in the pediatric population. [ABSTRACT FROM AUTHOR]

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies. [ABSTRACT FROM AUTHOR]

Nasal obstruction (NO) is a common clinical symptom characterized by a subjective sensation of insufficient airflow through the nasal cavity and may result from various factors, including changes in nasal anatomy, inflammatory conditions, tumoral lesions, and other etiologies. While a thorough medical history and physical examination can often identify its cause, imaging is usually necessary to fully understand the problem. Computed tomography (CT) is the primary imaging modality used to evaluate the nasal cavity and paranasal sinuses, allowing for the identification of potential causes and structural abnormalities. However, when soft tissue characterization is required, magnetic resonance imaging (MRI) is also useful. Understanding the anatomical and pathological basis of NO is crucial for accurate diagnosis and appropriate management. Imaging techniques provide valuable information for identifying the underlying causes of NO and guiding treatment decisions. This article reviews the normal anatomy of the nasal cavity and adjacent paranasal sinuses as well as the several conditions that may affect breathing comfort (tumors, inflammatory diseases, bony and cartilaginous anatomical variants, and "nonobstructive" mucosal thickenings), showing their normal presentation on CT and MRI. [ABSTRACT FROM AUTHOR]

Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice. [ABSTRACT FROM AUTHOR]

Measuring nasal obstruction should be mandatory before every nasal surgery to determine the necessary surgical steps and to separate mucosal congestion from skeletal deformity. Rhinomanometry is considered the "golden standard" for measuring nasal airway resistance. An extension of the diagnostic power was achieved by the introduction of the four-phase rhinomanometry (4PR), which provides additional information about the influence of the elasticity of the nasal wall. Also, a high correlation to the subjective sensing of obstruction could be achieved by the introduction of logarithmic parameters. The parameters of 4PR could be classified by evaluating 36,500 measurements. The International Standardization Committee on the Objective Assessment of the Upper Airway (ISCOANA) determined it as the new standard. Adding a visual analog scale (VAS) to every measurement is a documentation of the feeling of obstruction at the moment of measurement. Practical hints for 4PR are given. The determination of obstruction for both nasal sides or the calculation of the total nasal resistance should be followed by a second analysis of the detailed obstruction anatomy. In the future, pressure losses or temperature gradients can be determined by computational fluid dynamics (CFD). A reliable way to simulate the success of single surgical steps with a high didactical meaning is the three-dimensional (3D) print of sliced nose models and to measure the effect of stepwise mechanical corrections. [ABSTRACT FROM AUTHOR]