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Background: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. Materials and methods: We retrospectively analyzed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. Results: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm 2 and 147.60 mm 2 for men and women respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. Conclusions: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system. The project was previously reviewed and approved by the local ethics and research committees of the University with the approval number AH19-00002 on April 25, 2019.

Nostril stenosis is typically caused by retraction and contraction after trauma or infection, although loss of nasal tissue is not common during rhinoplasty. This clinical report describes the fabrication of a nasal stent to replace the lost columella and a columella prosthesis for a patient who had had reconstructive surgery for nasal valve collapse and a missing columella. The stent established a comfortable means of nasal air exchange that was also esthetically acceptable. The stent also provided the necessary support for the nasal tissue before further nasal reconstructive surgeries.

Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve function. The most common deformities requiring alar base modification include wide nasal base, alar flaring, large nostril size, and asymmetries of nostrils or alae. There are 3 basic types of excision on alar base surgery. (1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive flaring on the frontal view. Nostril sill excision is the technique which is used to decrease interalar distance and nostril sill length, and reduce the size of nostril. The combined alar wedge and nostril sill excision is used in cases with wide alar base and additionally, there is excessive flaring and large alar lobule.

Case 1: An 11-year-old boy presented to the casualty department complaining of pain over the tip of his nose and difficulty in nasal breathing following a fall on the ground that happened 2 days ago. He also reported a short-lasting, self-limited episode of epistaxis from his right nostril.

In this study, we present a modified technique for primary cleft lip repair with a rotation triangular flap from the cleft lateral side to reconstruct the nasal floor; and evaluate the outcome compared with traditional Millard repair. 40 patients with unilateral cleft lip were included in this research. The patients were divided into 2 groups; 17 patients treated with the Millard technique, and 23 patients treated with the newly modified technique. 14 measurement indexes were employed to evaluate the nose-lip morphology of postoperative patients with UCCL in standardized photographs preoperatively, postoperatively and 1-year follow-up. For lip symmetry, statistical significance was detected in the measurements of the vertical philtral height ratio indicating that the newly modified technique resolve the shortage of lip height on the cleft side 1-year follow-up. ( P The modified unilateral cleft lip repair with rotation triangle flap from the cleft lateral side was beneficial in the correction of lip and nasal deformity in and had positive effects on labial symmetry.

The treatment of qualitative olfactory disease is challenging. We aimed to treat parosmia using a new minimally invasive surgical technique-the olfactory cleft blocking technique- by preventing odorants from reaching the olfactory epithelium. A novel surgical procedure for blocking the anterior and inferior openings of the olfactory cleft was accomplished in a patient with unilateral persistent peripheral parosmia. The HRCT and endoscopy were performed preoperatively and postoperatively to evaluate the anatomical structure of the olfactory cleft. The T&T olfactometer was used to assess the preoperative and postoperative olfactory function. After surgery, the patient's parosmia disappeared. Endoscopic examination and CT scan showed complete obstruction of the anterior and inferior portions of the olfactory cleft. No recurrence was reported during a 2-year follow-up. No surgical complications were reported except olfactory loss in the operative nostril. For patients with long-term unilateral peripheral olfactory dysfunction, the olfactory cleft blocking technique seems a novel, simple, safe and effective treatment. Further studies are required with a larger number of patients in order to access success rate.

The aim of this study was to evaluate the pharmacokinetic bioequivalence of a generic budesonide nasal spray and a branded product in healthy Chinese subjects under fasting condition. A single-center, single-dose, randomized, open-label, crossover study was conducted in 32 healthy Chinese subjects under fasting condition. The subjects were administered 256 μg of generic budesonide nasal spray (test drug) or branded budesonide nasal spray (RHINOCORT AQUA, reference drug), respectively. For each period, the subjects were administered with 64 μg of budesonide per spray and 2 sprays for each nostril followed by a washout period of 7 days. Plasma concentration of budesonide was determined by a validated high-performance liquid chromatography-tandem mass spectrometry method. The pharmacokinetic (PK) parameters were calculated, and the bioequivalence was compared using the noncompartment model with the Phoenix WinNonlin 7.0 program. Results show that the 90% confidence intervals of the test/reference ratios of maximum concentration, area under the plasma concentration-time curve from time 0 to the last measurable concentration, and area under the plasma concentration-time curve from time 0 to infinity for the budesonide concentration were 84.8% to 102.7%, 84.6% to 94.4%, and 85.4% to 95.2%, respectively, all fall within the bioequivalent range of 80% to 125%. The test and reference budesonide nasal sprays were PK bioequivalents in healthy Chinese subjects with comparable PK parameters. No serious adverse events were reported, and the 2 products have a good and similar safety profile.

Objectives To determine the effect of povidone-iodine (PVP-I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold on quantitative polymerase chain reaction (qPCR) of SARS-CoV-2 in outpatients. Study design Three arm, triple blinded, randomized, placebo-controlled clinical trial. Methods Participants were randomized within 5 days of testing positive for COVID-19 to receive nasal sprays containing either placebo (0.9% saline), 0.5% PVP-I, or 2.0% PVP-I. NP swabs for qPCR analysis were taken at baseline, 1-hour post-PVP-I spray (2 sprays/nostril), and 3 days post-PVP-I spray (20 sprays/nostril). Symptom and adverse event questionnaires were completed at baseline, day 3, and day 5. University of Pennsylvania Smell Identification Tests (UPSIT) were completed at baseline and day 30. Results Mean cycle threshold (Ct) values increased over time in all groups, indicating declining viral loads, with no statistically significant difference noted in the rate of change between placebo and PVP-I groups. 2.0% PVP-I group showed statistically significant improvement in all symptom categories, however also reported a high rate of nasal burning. Olfaction via UPSIT showed improvement by at least one category in all groups. There were no hospitalizations or mortalities within 30 days of study enrollment. Conclusion Saline and low concentration PVP-I nasal sprays are well tolerated. Similar reductions in SARS-CoV-2 nasopharyngeal viral load were seen over time in all groups. All treatment groups showed improvement in olfaction over 30 days. These data suggest that dilute versions of PVP-I nasal spray are safe for topical use in the nasal cavity, but that PVP-I does not demonstrate virucidal activity in COVID-19 positive outpatients. This article is protected by copyright. All rights reserved.

The lateral line system and its innervation were examined in the masu salmon Oncorhynchus masou masou. The species has 8 cephalic canals (supraorbital, infraorbital, otic, preopercular, mandibular, postotic, supratemporal, and temporal portion of trunk), 1 trunk canal and 9 superficial neuromast groups (rostral, nostril, preinfraorbital, postocular, cheek and supratemporal groups in the cephalic groups, and predorsal, trunk accessory and caudal fin groups in the trunk groups). The components are generally similar to those in many other teleosts, the lateral line system of O. m. masou is distinctive in having a preinfraorbital superficial neuromast group and lacking infraorbital, mandibular and opercular superficial neuromast groups. The lateral line system of O. m. masou is compared with some other species of Oncorhynchus.

Background- Vataja Pratishyaya is a Nasagataroga and one among five types of Pratishyaya. It is most common and annoying nasal problem which affect the people of all age group. Vataja Pratishaya is a disease which possesses symptoms like Nasagata Tanusrava, Kshavathu and Nasaavarodha. These symptoms are also found in allergic rhinitis which is induced by an IgE mediated inflammation of the nasal mucosa. While treating the Pratishyaya, special attention should be given to the stages of the disease because the treatment approach of Amavastha, Pakwavastha and Dushta stages are entirely different. Nasya is the most important Shodhana method in Urdhwgatrugata Vyadhies and can execute Uttamanga Shuddhi, Snehana, and Swedana. The continuous sneezing is a main disturbing symptom of allergic rhinitis. Shunthyadi Taila was selected for this purpose which is given in Kshavathu Adhikara for managing the allergic conditions of the nose. Method – The patient with Vataja Pratishyaya was given two courses of Shunthyadi Taila Nasya, each course consisting of one sitting per day for 7 days. Six drops of Shunthyadi Taila were poured into each nostril during each session. Result- Patients clinical status was assessed on 7th, 15th, 21st and 28th day. Remission of symptoms like sneezing, rhinorrhoea, itching, nasal congestion etc. was observed after 2 courses of treatment. Patient was followed up for 1 month and no recurrences of symptoms were observed. Key words: Vataja Pratishyaya, allergic rhinitis, Shunthyadi Taila.

This perfectly matched, double-blinded, placebo-controlled trial study was performed to investigate the efficacy of triamcinolone acetonide (TAA)-impregnated Gelfoam nasal pack in management of different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS). One hundred and four patients with bilateral CRSwNP undergoing ESS were selected and randomized to receive TAA-soaked nasal packing in one nostril and saline-impregnated dressing contra-laterally. Validated Perioperative Sinus Endoscopy (POSE) scoring system was used to assess the participants’ condition at postoperative months 1, 3, 6, 12, and 18. The treatment side of eosinophilic CRSwNP (EosCRSwNP) group had significantly better endoscopic scores than the contralateral control side in all follow-up visits (P

Introduction. The main place of pathogens accumulation and growth in childhood is the lymphoid tissue of the nasopharynx. Often, the development of rhinosinusitis begins with the adenoiditis. The most vulnerable in this situation are the children of preschool age with hyperplasia of the pharyngeal lymphoid ring. In this group, recurrent diseases of the upper respiratory tract are observed. Objective: optimization of the program for therapy of acute rhinosinusitis in children with pharyngeal lymphoid ring hyperplasia. Materials and methods. We observed 100 patients aged 2 to 6 years randomly divided into 2 groups of 50 children each. Regimen of 0.05% xylometazoline solution application: one injection into each nostril twice a day. Sodium chloride 0.9% was used in the form of nasal irrigation in the first group of children twice a day before xylometazoline administration. Clinical method consisted of the evaluation of anamnesis, clinical pattern, general clinical research methods. We took a smear for cytomorphological analysis of the nasal mucosa; performed staining with Giemsa’s diluted solution followed by microscopy, quantitative determination of the secretory IgA (sIgA) in saliva by enzyme immunoassay. The results were processed by the Mann-Whitney test, Fisher’s exact test. Results. Application of 0.05% xylometazoline in combination with a nasal irrigation by NaCl 0.9% has a statistically significant regenerating and sanation effect on the nasal mucosa. Use in xylometazoline with nasal irrigation by sodium chloride 0.9%, in contrast to xylometazoline administration without preparation of the nasal cavity, is not associated with a reduction of sIgA level in saliva, but leads to some increase of it. Conclusion. The use of 0.05% xylometazoline solution with nasal irrigation by sodium chloride 0.9% in the therapeutic regimen for acute rhinosinusitis in children with hyperplasia of the pharyngeal lymphoid ring has significant advantages over the xylometazoline administration without preparation of the nasal cavity., Актуальность. Основным местом скопления и роста возбудителей в детском возрасте является лимфоидная ткань носоглотки. Часто развитие риносинусита начинается с аденоидита. Наиболее уязвимыми в этой ситуации оказываются дети дошкольного возраста с гиперплазией лимфоглоточного кольца. В этой группе отмечается рекуррентное течение заболеваний верхних отделов респираторного тракта. Цель исследования: оптимизация программы терапии острых риносинуситов у детей с гиперплазией лимфоглоточного кольца. Материалы и методы. Под наблюдением находилось 100 пациентов в возрасте от 2 до 6 лет, случайно распределенных в 2 группы по 50 детей в каждой. Режим применения 0,05% раствора ксилометазолина: по одному впрыскиванию в каждый носовой ход два раза в сутки. Натрия хлорид 0,9% применялся в виде носового душа у детей первой группы два раза в сутки перед использованием ксилометазолина. Клинический метод состоял из оценки данных анамнеза, клинической картины, общеклинических методов исследования. Брался мазок для цитоморфологического анализа слизистой оболочки носа; проводилось окрашивание препаратов разведенным раствором Гимзы с последующей микроскопией, количественное определение секреторного IgA (sIgA) в слюне методом иммуноферментного анализа. Результаты обрабатывались посредством критерия Манна — Уитни, критерия Фишера. Результаты. Применение 0,05% ксилометазолина в сочетании с носовым душем NaCl 0,9% оказывало статистически значимое регенерирующее и санирующее действие на слизистую оболочку носа. Использование ксилометазолина с предварительным носовым душем натрия хлоридом 0,9% в отличие от применения ксилометазолина без подготовки полости носа не сопровождается снижением уровня sIgA в слюне, а приводит к его некоторому повышению. Заключение. Использование 0,05% раствора ксилометазолина с предварительным носовым душем раствором натрия хлорида 0,9% в программе терапии острых риносинуситов у детей с гиперплазией лимфоглоточного кольца имеет существенные преимущества перед применением ксилометазолина без предварительной подготовки полости носа., Актуальність. Основним місцем скупчення і зростання збудників у дитячому віці є лімфоїдна тканина носоглотки. Часто розвиток риносинуситу починається з аденоїдиту. Найбільш уразливими в цій ситуації є діти дошкільного віку iз гіперплазією лiмфоглоткового кільця. У цій групi відзначається рекурентний перебіг захворювань верхніх відділів респіраторного тракту. Мета дослідження: оптимізація програми терапії гострих риносинуситiв у дітей iз гіперплазією лімфоглоткового кільця. Матеріали і методи. Під спостереженням перебувало 100 пацієнтів віком від 2 до 6 років, випадково розподілених у 2 групи по 50 дітей у кожній. Режим застосування 0,05% розчину ксилометазоліну: по одному впорскуванню в кожну ніздрю два рази на добу. Натрію хлорид 0,9% застосовувався як носовий душ у дітей першої групи два рази на добу перед використанням ксилометазоліну. Клінічний метод складався з оцінки даних анамнезу, клінічної картини, загальноклінічних методів дослідження. Брався мазок для цитоморфологічного аналізу слизової оболонки носа; проводилося фарбування препаратів розведеним розчином Гімзи iз подальшою мікроскопією, кількісне визначення секреторного IgA (sIgA) у слині методом імуноферментного аналізу. Результати оброблялися за допомогою критерію Манна — Уїтні, критерію Фішера. Результати. Застосування 0,05% ксилометазоліну в поєднанні з носовим душем NaCl 0,9% мало статистично значущу регенеруючу і сануючу дію на слизову оболонку носа. Використання 0,05% розчину ксилометазоліну iз попереднім носовим душем натрію хлоридом 0,9% на відміну від застосування ксилометазоліну без підготовки порожнини носа не супроводжується зниженням рівня sIgA в слині, а призводить до його деякого підвищення. Висновки. Використання 0,05% розчину ксилометазоліну iз попереднім носовим душем розчином натрію хлориду 0,9% у програмі терапії гострих риносинуситів у дітей iз гіперплазією лімфоглоткового кільця має істотні переваги перед застосуванням ксилометазоліну без попередньої підготовки порожнини носа.

This study provides sufficient information on the anatomical investigation and the morphometrical analysis of the nasal cavity of Egyptian goat and Egyptian Baladi dog. The sagittal and the cross (transverse) sections at the different levels were performed on twenty heads of those animals. The nasal cavity was typically cone-shape in goat and a slight narrow elongated cone-shape in dog. It was completely divided by the nasal septum in both species except the caudal part of the nasal cavity of goat was partially divided. The nostril of the goat was nearly horizontal slit-like in form, directed ventromedially toward the philtrum. Whereas, the nostril of the dog was somewhat comma-shaped with its wide part directed medially toward the nasal septum. In the sagittal section, the nasal conchae were included in goat and dog, the dorsal nasal concha, the ventral nasal concha, the middle nasal concha and the ethmoidal conchae. The dorsal nasal concha was the longest concha in both animals. In the cross section, the dorsal nasal concha in goat was formed the dorsal conchal sinus at the level of the third premolar teeth and caudally extended into the frontal sinus. The ventral nasal concha was not formed sinus but its spiral lamellae enclosed the recesses. Moreover, the middle conchal sinus was appeared at the level of the first molar teeth. In this section, all the nasal conchae of dog were formed recesses (conchal sinuses absent).

Bone maxillary post traumatic defects create significant aesthetic and functional handicaps remaining a critical challenge for surgical reconstruction, among all the alternatives that exist, transportation osteogenesis remains a body ally for having satisfactory results. We present a case of 26 mm of maxillary reconstruction with bifocal transportation osteogenesis using a novel technique, with a custom-made device. At the end of the consolidation period, the patient had clinical formation of new tissue corroborated radiographically. We achieve an adequate dentoalveolar arch, upper lip vestibule, gingiva and palatal fibromucosa similar to the adjacent tissue, improvement of facial contour, labial projection, nostril floors and masticatory function.

True unilateral posterior crossbite (TUPC) requires unilateral expansion to prevent nonocclusion at the noncrossbite (NC) side. The recommended osteotomies for TUPC after sutural closure are anterior, lateral, and posterior osteotomies only on the crossbite (C) side and median osteotomy of the midpalatal suture, i.e., unilateral surgically assisted rapid maxillary expansion (SARME). The goal was to assess airway and perinasal soft tissue outcomes after SARME. Data from 16 patients (8 males, 8 females; mean age 18.38 ± 1.45 years) were retrospectively assessed after unilateral SARME. The expansion (twice daily: 0.5 mm/day) and retention periods comprised 3 weeks and 6 months, respectively. Stereophotogrammetric images were used for soft tissue assessment; cone beam computed tomography (CBCT) was used to evaluate the anterior nasal airway. Statistical analyses were performed. Using linear measurements, soft tissue distances of the alar base and alare to midsagittal plane (MSP) were significantly increased on the C side. A significant decrease was observed for the distance from the lower nostril point to the MSP on the NC side compared to a significant increase on the C side. Comparing the C and NC sides, the changes were significantly higher on the C side for all parameters except the upper nostril point to the MSP distance. Cheek volume was significantly higher on the C side. Volume changes of the anterior nasal airway (ANA) were significantly increased on the C side, but volume changes between NC and C were not significantly different. Unilateral SARME led to significant expansion of ANA on the C side, but did not lead to asymmetry in the nasal region or have adverse effects on the airway or perinasal soft tissues. Thus, this novel treatment method may be useful in the treatment of patients with TUPC.

Summary The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face.

BACKGROUND Autologous conchal cartilage is becoming increasingly popular as a source of material for secondary reconstruction. The aim of this study was to verify the effect of dichotomous autologous conchal cartilage transplantation in the treatment of unilateral cleft lip nasal deformity. METHODS Eighteen patients (10 males and 8 females) with unilateral cleft lip nasal deformity treated from August 2018 to August 2019 were selected for the study. The cut C-shaped conchal cartilage was trimmed into a strip shape and a shield shape and transplanted into the alar cartilage and the tip of the nose, respectively. The effect of the operation was evaluated in terms of patient satisfaction, two-dimensional linear quantitative results, and three-dimensional spatial differences after the operation. RESULTS During follow-up from 6 months to 2 years, the nasal appearance of 18 patients was significantly improved. The postoperative patient satisfaction survey revealed more than 93% satisfaction for each research index. Two-dimensional linear quantitative analysis revealed that the height of the nasal columella and nostril was significantly increased and that the nasal base and breadth were significantly decreased after the operation. Evaluation of the three-dimensional spatial difference between the unaffected side and the affected side before and after the operation revealed a significant decrease in the difference in the soft tissue volume between the unaffected side and the affected side (P < 0.05). CONCLUSIONS Dichotomous autologous conchal cartilage transplantation is an ideal method for the treatment of unilateral cleft lip nasal deformity.

Objectives: Several studies promoted anosmia as a possible isolated symptom for coronavirus disease 2019 (COVID-19). No studies used feasible methods of smell testing that the public would use to address the accuracy of these claims. Methods: This is a single-center study conducted between April 2020 and June 2020. The sense of smell was tested in vitally stable suspected COVID-19 patients with no/mild upper respiratory tract infection symptoms prior to nasopharyngeal swabbing for reverse-transcriptase polymerase chain reaction. Patients were instructed to close their eyes. Each nostril was tested separately while the other was blocked with the patient’s index finger. Patients inhaled from 2 concealed vials (coffee and strawberry essence) consecutively, kept within 30 cm of the nostril for 60 s. Patients who could not identify both odors with both nostrils were recorded as “anosmia.” Results: Out of 346 eligible subjects, 43 had anosmia of which 26 (60%) tested COVID-19 positive. χ2 test showed a p value p value Conclusion: Given the low sensitivity (30%) of this method in detecting COVID-19 infection, we conclude that this method is not a useful screening tool for COVID-19 infection. The moderate negative predictive value (80%) is nongeneralizable.

The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.

Long-term follow-up results of many surgical techniques for lip adhesion are unavailable. Thus, we report the surgical results of patients who underwent lip adhesions performed by a single surgeon. We retrospectively analyzed two-dimensional photographs of 29 patients aged 1 year who underwent lip adhesion and definite lip repair. Among these patients, we analyzed the photographs of 20 patients aged 6 years who underwent secondary rhinoplasty. The ratio of the cleft side length to the noncleft side length was calculated. Only the upper lip length in the photographs of 1-year-olds was measured; both the upper lip and nose lengths were measured in the photographs of 6-year-olds. Lip width, vermilion height, and medial lip height on the cleft and non-cleft sides of 1-year-olds were not significantly different; the alar base width ratio was 1.17 ± 0.15, and the lateral lip height ratio was 0.91 ± 0.09 (P

Closure of nasal defect remains a challenge for surgeons. There are several ways to do nasal reconstruction, including donor site for nasal reconstruction due to its vascularity that is superior to other areas. Methods: This is a case report of a 75-year old male patient with Squamous Cell Carcinoma on his left nostril who underwent wide excision. This action left a 4-cm defect, whilst the nasal septum remained intact. This defect closure was using V-Y advancement full thickness nasolabial flap in one step. This defect closure was using V-Y advancement full thickness nasolabial flap in one step. Results: The defect closure was performed with tum over local (nasobialis) flap from the left side of the nasal cartilage. The superiority of this flap, it is able to be performed bulking, so that closure with turn over local nasolabial flap has been a sole option in nostril reconstruction for decades, which gave very good cosmetic results. After being followed for 1 month after surgery, the flap was viable, the contour was well formed, the scar was minimal, and there was no respiratory disruption. The patient was satisfied by the results. Conclusion: Nasolabial turn over local flap can be used as an option to close a relatively wide nostril

Hong Loi Nguyen,1 Van Minh Nguyen,2 Xuan Phu Tran1 1Odonto-Stomatology Center, Hue Central Hospital, Hue City, Vietnam; 2Faculty of Odonto-Stomatology, Hue University of Medicine and Pharmacy, Hue University, Hue City, VietnamCorrespondence: Hong Loi NguyenOdonto-Stomatology Center, Hue Central Hospital, 16 Le Loi street, Hue City, 530000, VietnamTel +84913498549Email drloivietnam@yahoo.com.vnIntroduction: Congenital cleft lip, with or without cleft palate, is the most common deformity of the face. Primary plastic surgery for rehabilitation and esthetics is important for patients and their parents; however, secondary deformities of the lip and nose can occur after the primary surgery. Therefore, we performed assessment of secondary cleft lip/nasal deformities to aid in planning of surgical repair of these deformities.Materials and Methods: Forty-six patients with unilateral cleft lip, with or without cleft palate, were operated with different techniques and examined post-surgery at the Department of Maxillofacial Surgery, University of Medicine and Pharmacy Hospital and Center of Odonto-Stomatology, Hue Central Hospital. They were assessed according to Motier’s post-operative evaluation scale (1997), including the red lip, white lip, scars, and nose.Results: V notch and defect on the shift line were the most common deformities on the red lip (52.2%). About 34.8% of the patients had a short white lip on the cleft side. Straight and prominent scars were observed in 52.2% of the patients. The most common deformities of the nose were septal deviation (78.3%), followed by defects in the upper part of the nostril contour (78.3%), narrow sill (52.2%), and low position of the ala (47.8%).Conclusion: Secondary cleft lip/nasal deformities are unavoidable. It is necessary to develop a plan for surgical repair of these deformities. There is no single method of cleft lip surgery that gives perfect results. Therefore, clinicians choose a combination of methods to bring optimal results for each patient.Keywords: unilateral, cleft lip/palate, secondary deformities

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P=0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P=0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections.

Background Despite the wide range of cleft lip morphology, consistent scales to categorize preoperative severity do not exist. Machine learning has been used to increase accuracy and efficiency in detection and rating of multiple conditions, yet it has not been applied to cleft disease. The authors tested a machine learning approach to automatically detect and measure facial landmarks and assign severity grades using preoperative photographs. Methods Preoperative images were collected from 800 unilateral cleft lip patients, manually annotated for cleft-specific landmarks, and rated using a previously validated severity scale by eight expert reviewers. Five convolutional neural network models were trained for landmark detection and severity grade assignment. Mean squared error loss and Pearson correlation coefficient for cleft width ratio, nostril width ratio, and severity grade assignment were calculated. Results All five models performed well in landmark detection and severity grade assignment, with the largest and most complex model, Residual Network, performing best (mean squared error, 24.41; cleft width ratio correlation, 0.943; nostril width ratio correlation, 0.879; severity correlation, 0.892). The mobile device-compatible network, MobileNet, also showed a high degree of accuracy (mean squared error, 36.66; cleft width ratio correlation, 0.901; nostril width ratio correlation, 0.705; severity correlation, 0.860). Conclusions Machine learning models demonstrate the ability to accurately measure facial features and assign severity grades according to validated scales. Such models hold promise for the creation of a simple, automated approach to classifying cleft lip morphology. Further potential exists for a mobile telephone-based application to provide real-time feedback to improve clinical decision making and patient counseling.

Herein, we describe Panophrys congjiangensissp. nov. obtained from the Yueliangshan Nature Reserve, Congjiang County, Guizhou Province, China. Phylogenetic analyses based on the mitochondrial genes 16S rRNA and COI indicated that this new species represented an independent lineage, closely related to P. leishanensis. The uncorrected genetic distances between the new species and its closest congener, P. leishanensis, were 3.0% for 16S rRNA and 8.4% for COI. The new species is distinguished from its congeners by a combination of the following morphological characteristics (1) medium body size (SVL 28.6–33.4 mm in males and 38.4–40.2 mm in females); (2) a small horn-like tubercle at the edge of each upper eyelid; (3) the tympanum distinctly visible (TD/ED ratio 0.47–0.66); (4) vomerine teeth absent; (5) the tongue not notched behind; (6) a narrow and unobvious lateral fringe on toes; (7) relative finger lengths II < I < V < III; (8) rudimentary webs on toes; (9) hindlimbs slender, heels overlapping when thighs are positioned at right angles to the body; (10) two metacarpal tubercles on the palm, with the inner metatarsal tubercle long and oval-shaped; (11) the tibiotarsal articulation reaching the nostril when the leg is adpressed and stretched forward; (12) dorsal skin rough with numerous orange–red granules, ventral surface smooth; (13) a single internal subgular vocal sac present in males; and (14) in breeding males, weak gray-black nuptial pads with black nuptial spines present on the dorsal surface of the bases of the first and second fingers. To date, the new species is only known from the type locality.

Pulsed-field gel electrophoresis (PFGE) has historically been considered the gold standard in fingerprinting bacterial strains in epidemiological studies and outbreak investigations, little is known regarding its use in individual clinical cases. The current study detailed two clinical cases in which PFGE helped to determine the source of their methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Patient A was found to have MRSA bacteremia after trauma in her pelvic area. MRSA was also found in her groin but not in her nostril and rectum. PFGE was performed that showed variable bands of her MRSA isolates from blood and groin, suggestive of different strains of MRSA. Her MRSA bacteremia was determined to be unrelated to her pelvic trauma. Patient B was found to have MRSA bacteremia after colonoscopy. MRSA was also found in his nostril and rectum. PFGE was performed that showed variable bands of his MRSA isolates from blood and rectum but identical bands of MRSA isolates from his blood and nostril. His MRSA bacteremia was determined to be unrelated to his colonoscopy procedure. The current study demonstrates the use of PFGE to rule out the source of bacteremia in individual clinical cases.

Background: The higher the energy level, the more efficient body. The more efficient body, the better feel and the more will use talent to produce outstanding results. Breathing exercise is one of the yogic techniques that can produce different physiological responses in healthy individuals. Aim: determine the effect of the application of an alternate nostril breathing exercise on fatigue and sleep quality pattern among nursing students enrolled in the Faculty of Nursing, Alexandria University, Egypt. Design: A quasi-experimental design was used to conduct this study. Subjects: A simple random sample of 100 volunteers of first-year nursing students enrolled in the winter semester of 2019 (males and females). Tools: Two tools were used to collect the necessary data for the present study. The tool I: Alternate nostril breathing assessment and tool II: Iowa Fatigue Scale. Results: indicated that regular practice of alternate nostril breathing increases parasympathetic activity. Participants experienced decrease levels of fatigue and improving the quality of sleep pattern. The majority of participants agreed that work drains their energy every day, that they never have enough time between classes to recover their energy, and that they dread waking up to another day of work. Conclusion: Implementation of alternate nostril breathing exercises helped in decreasing nursing students' fatigue levels before, during, and after their practice. Also, it improved the quality of sleep patterns. Recommendations: Apply the proposed protocol of alternate nostril breathing techniques. The developed colored illustrated booklet regarding the alternate nostril breathing has to be distributed to the newly enrolled nursing students each year. As well as fatigue in nursing students needs further study including the application of the alternate nostril breathing exercises that address chronic and acute fatigue and promote recovery.

Summary: Reconstruction following excision of skin lesions at the cosmetically sensitive junction between the alar base and upper lip continues to be challenging for surgeons. We describe an advancement flap from the nasolabial fold area to reconstruct such defects. Our case demonstrates a gentleman with a clinically diagnosed BCC between the alar base and upper lip. An advancement flap from the nasolabial area was designed to reconstruct the defect, with two Burrow's triangles excised to prevent standing cones. The scar of the two Burrow's triangles falls over the nasolabial fold, resulting in the integration of the scar within the natural line. This flap design also maintains of the level of the upper lip, the shape and position of the nostril, and minimises flattening of the philtrum. Excellent cosmetic results were seen six weeks post-op.

The macromorphology of olfactory organ was studied in moon wrasse Thalassoma lunare and sixbar wrasse T. hardwicke. There are two nostrils in the olfactory organ. Thin walls of the anterior tubular nostril can easily close, the posterior nostril contains a valve. The olfactory rosette is absent and is replaced by the olfactory disk and vertical membrane, morphology structures of the olfactory organ previously unknown in fish. The disk is located on the rostral bottom part of olfactory cavity. Low crest-folds cover the disk surface that are probably the vestigial structures of primary olfactory folds. The expressiveness of crest-folds, disk thickness and shape are different in the moon wrasse and sixbar wrasse. In both species only one large ventilation lacrimal nasal sac is present adjacent below the olfactory cavity with the entrance at the cavity bottom caudal from the disk. A scheme of ventilation of the olfactory cavity is introduced. The possibility of receiving the olfactory information is discussed for wrasses staying in the ground at the time of avoidance of danger.

BACKGROUND Patients with secondary deformities associated with unilateral cleft lip and nose might also suffer from nostril stenosis due to a lack of tissue volume in the nostril on the cleft side. Here, we used full-thickness skin grafts (FTSGs) to reduce nostril stenosis and various methods for skin volume augmentation. We compared the changes in the symmetry of both nostrils before and after surgery. METHODS From February 2016 to January 2020, 34 patients underwent secondary cheiloplasty and open rhinoplasty for secondary deformities of the unilateral cleft lip and nose with nostril stenosis. FTSG was used on the nostril floor, nasal columella, and alar inner lining. The measured nasal profile included the nostril surface, nostril circumference, width of the nostril floor, and distance from the alar-facial groove to the nasal tip. The "overlap area," which was defined as the largest overlapping area when the image of the cleft nostril was flipped to the left and right and overlaid on the image of the normal side nostril, was also calculated. The degree of symmetry was evaluated by dividing the value of the cleft side by that of the normal side of each measured profile and expressed as "ratios." RESULTS The results of all profile ratios, except for the nostril floor width, became significantly close to 1, which represents full symmetry. The overlap area ratio improved from 62.7% to 77.3%, meaning that the length and width of the nostril as well as the overall shape became similar (p< 0.05). CONCLUSION When performing cleft rhinoplasty with nostril stenosis, FTSG is useful to achieve symmetry in the nostril size and shape. Skin grafting is simpler to perform than the other types of local flap, and the results are generally satisfactory.

Here we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p

BACKGROUND A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors' objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty. METHODS A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally. RESULTS Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio. CONCLUSIONS Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Highlights • CSF leak is an exceedingly rare complication post Nasal swab. • The Underlying pathophysiology in this case is poorly understood. • Adverse events may still occur due delicate anatomyof the nose and highlights the importance of alternative methods of screening in certain cases., We report the case of a 59 year old male who presented with 2 months of persistent rhinorrhoea from left nostril post a nasal swab done for coryzal symptoms at the peak of the COVID-19 pandemic. Beta-2-transferrin confirmed it to be a CSF leak and imaging showed a left middle cranial fossa encephalocele herniating into the sphenoid sinus as the site of the leak post swab. The leak was treated endoscopically. We describe the case history and management of this exceedingly rare complication of nasal swab for respiratory testing.

The olfactory organs of two African lungfishes,Protopterus amphibiusandP. dolloi, were investigated using a stereo microscope and a compound light microscope and were described anatomically, histologically, and histochemically. Like other lungfishes, these species present the following general features: i) elongated olfactory chamber (OC), ii) anterior nostril at the ventral tip of the upper lip, iii) posterior nostril on the palate of the oral cavity, iv) lamellae with multiple cell types such as olfactory receptor neurons, supporting cells, basal cells, lymphatic cells, and mucous cells (MC), and vi) vomero-like epithelial crypt (VEC) made of glandular epithelium (GE) and crypt sensory epithelium. Some of these features exhibit differences between species: MCs are abundant in both the lamellar and inner walls of the OC inP. amphibiusbut occur only in lamellae inP. dolloi. On the other hand, some between feature differences are consistent across species: the GE of bothP. amphibiusandP. dolloiis strongly positive for Alcian blue (pH 2.5)-periodic acid Schiff (deep violet coloration), and positive with hematoxylin and eosin and with Masson’s trichrome (reddish-brown staining), unlike the MCs of the two species which stain dark red with both Alcian blue (pH 2.5)-periodic acid Schiff and Masson’s trichrome but respond faintly to hematoxylin and eosin. The differing abundance of MCs in the two lungfishes might reflect different degrees in aerial exposure of the olfactory organ, while the neutral and acid mucopolysaccharide-containing VEC, as indicated by staining properties of the MCs, is evolutionary evidence thatP. amphibiusandP. dolloiare the closest living relatives to tetrapods, at least in the order Dipnoi.

Although many studies in the literature examine distances and angles about the nose, there are no clear standard values for different races and ethnic groups. The aim of this study is to determine the anthropometric measurement standards related to the external nose in Turkish young adults between the ages of 18 and 25. The subjects participating in this study were 100 female and 100 male volunteers. Six landmarks (nasion, subnasale, pronasale, alar, subalar and maxillofrontale) on the nose were chosen, and these landmarks were identified on the photographs. Then, using these landmarks, a total of seven distances (nose height, dorsum of nose length, distance between the subnasale and pronasale, nose width, right nostril floor width, left nostril floor width and root of nose width) and four angles (nasofrontal, nasofacial, nasomental and nasolabial angles) measurements were made. There were statistically significant differences between gender in nine parameters. One parameter (nasofrontal angle) is higher in females, and seven parameters (nose height, dorsum of nose length, nose width, right nostril floor width, left nostril floor width, root of nose width and nasofacial angle) are higher in males. It is accepted that distances and angles about the nose differ according to race and ethnicity. The authors believe that the results obtained in this study will help determine the standard values that can be used for the Turkish population between the ages of 18 and 25.

Purpose State-of-the-art medical examination techniques (e.g., rhinomanometry and endoscopy) do not always lead to satisfactory postoperative outcome. A fully automatized optimization tool based on patient computer tomography (CT) data to calculate local pressure gradient regions to reshape pathological nasal cavity geometry is proposed. Methods Five anonymous pre- and postoperative CT datasets with nasal septum deviations were used to simulate the airflow through the nasal cavity with lattice Boltzmann (LB) simulations. Pressure gradient regions were detected by a streamline analysis. After shape optimization, the volumetric difference between the two shapes of the nasal cavity yields the estimated resection volume. Results At LB rhinomanometry boundary conditions (bilateral flow rate of 600 ml/s), the preliminary study shows a critical pressure gradient of −1.1 Pa/mm as optimization criterion. The maximum coronal airflow ΔA := cross-section ratio $$\frac{\mathrm{virtual surgery }}{\mathrm{post}-\mathrm{surgery}}$$ virtual surgery post - surgery found close to the nostrils is 1.15. For the patients a pressure drop ratio ΔΠ := (pre-surgery − virtual surgery)/(pre-surgery − post-surgery) between nostril and nasopharynx of 1.25, 1.72, −1.85, 0.79 and 1.02 is calculated. Conclusions LB fluid mechanics optimization of the nasal cavity can yield results similar to surgery for air-flow cross section and pressure drop between nostril and nasopharynx. The optimization is numerically stable in all five cases of the presented study. A limitation of this study is that anatomical constraints (e.g. mucosa) have not been considered.

BACKGROUND Le Fort I maxillary repositioning influences nasal morphology. In Asian cultures, upward nasal tip rotation with increased nostril exposure is considered aesthetically unpleasant and can have psychosocial consequences. This three-dimensional imaging-based study evaluated the effect of different Le Fort I maxillary movements on nasal tip rotation. METHODS Consecutive patients who underwent two-jaw orthognathic surgery (n = 107) were enrolled. To achieve a standard head orientation, preoperative and 1-week and 12-month postoperative cone-beam computed tomography-derived three-dimensional craniofacial models were superimposed. Tip rotation angle was calculated according to the Frankfort horizontal plane for all three-dimensional digital models. The final tip rotation angle change was defined as 12-month postoperative value minus preoperative value. Translational maxillary movement types (advancement versus setback and intrusion versus extrusion), postoperative maxillary segment locations (anterosuperior, anteroinferior, posterosuperior, or posteroinferior), and actual linear maxillary changes were noted. RESULTS Advancement (1.79 ± 5.20 degrees) and intrusion (2.23 ± 4.96 degrees) movements demonstrated significantly larger final tip rotation angle changes than setback (-0.88 ± 5.15 degrees) and extrusion (0.09 ± 5.44 degrees) movements (all p < 0.05). Postoperative anterosuperior location (2.95 ± 4.52 degrees) of the maxillary segment demonstrated a significantly larger final tip rotation angle change than anteroinferior (0.48 ± 5.65 degrees), posterosuperior (-1.08 ± 4.77 degrees), and posteroinferior (-0.64 ± 5.80 degrees) locations (all p < 0.05). Translational maxillary movement and actual linear maxillary change were not correlated with final tip rotation angle change. CONCLUSION Effects of Le Fort I maxillary repositioning on nasal tip rotation depend on movement types and maxillary segment location. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

Nasal irrigation is a grade A recommendation treatment, which is essential in many pathological conditions. Very heterogeneous practices are observed in paediatrics as a result of poor instruction in this technique. We propose to describe the nasal irrigation technique developed by a team of respiratory physiotherapists in Lille for the management of cystic fibrosis and bronchiolitis. This technique is intended for children over the age of 6 months, as it requires an oral breathing reflex and cough reflex that are not systematically acquired before this age. Nasal irrigation is performed on a 30° upward inclined plane on a calm and cooperative child, away from meals. The child is maintained gently, without pressure, in the fencing position with the head turned away from the practitioner. Using a continuous flow spray, the practitioner grasps the top of the upper nostril and irrigates the nostril for an average of 3 s (6 mL per nostril). These steps are then repeated until satisfactory patency is achieved in both nostrils. This technique constitutes a practical tool to help healthcare professionals and parents perform nasal irrigation in young children over the age of 6 months.

Background: Stress resulting from intimate partner violence (IPV) on pregnant women causes and sustains poor health and contributes to poor pregnancy and birth outcomes. Appropriate interventions to reduce stress in this population of women are warranted. Objective: To present a systematic review and the state of the science of evidence on alternate nostril breathing (ANB) as a holistic intervention for stress reduction for pregnant survivors of IPV, framed by complex adaptive systems theory and psychoneuroimmunology. Data Sources: Eight databases and reference lists of potential articles. Study Eligibility Criteria: Randomized controlled trials published between January 2013 and July 2019. Participants: Adults. Intervention: ANB. Study Appraisal and Synthesis Method: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: ANB is effective in reducing stress, as measured by psychological and biological indicators. Limitations: Studies were limited in ethnic and gender diversity, most of the populations being Asian Indian and predominately male. Conclusions: Use of ANB as a safe and effective holistic intervention for stress reduction shows promise, but research in pregnant survivors of IPV is limited. Implications: Stress reduction benefits may be significant for pregnant survivors of IPV and their fetuses, with minimal risk.

In contrast to previous reports, respiration-synchronous APT wave patterns display low sensitivity (53.3%) in our retrospective cohort of 15 PET ears, as diagnosed by characteristic symptoms and otoscopy. In 327 non-PET ears, the largest cohort of non-PET ears evaluated to date, respiration-synchronous APT wave patterns demonstrate high specificity for PET (93.9%), consistent with previous literature. APT performed solely at rest and with ipsilateral nostril respiration displays similar sensitivity for PET as the full battery of respiratory maneuvers. Pulse-synchronous wave patterns at rest may suggest an alternative neurotologic diagnosis requiring further workup, such as superior semicircular canal dehiscence. Ambient pressure tympanometry is a rapid, simple and widely available tool that can be integrated into general otolaryngology clinics and warrants further study in the evaluation of PET and neurotologic disorders.