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1.  Assessment of Nasal Airflow Resistance in the Healthy Population of Chattisgarh by Active Anterior Rhinomanometry 
The aim of present study was to define a normal range of total nasal airflow resistance in the healthy population of Chattisgarh. This study was conducted at the Department of Otorhinolaryngology, Medical College Raipur, Chattisgarh over 93 healthy adults. A proper otolaryngology examination was done prior to the study and all the subjects were free from any type upper respiratory tract infection. This was the main inclusion criteria for the present study. All the subjects were distributed according to age and sex. Active Anterior Rhinomanometry is the best recommended method for evaluating the objective assessment of nasal airflow resistance; it was preferred for the assessment of total nasal airway resistance in present study also. The present study concluded that the mean value of total nasal airway resistance was 0.21 at 150 Pa pressure. However the range of total nasal airway resistance was from 0.142 to 0.34 Pa/cm3/s at the same pressure. The present study presents the normal range and mean value of total nasal airway resistance for the healthy adult population of Chattisgarh. Total nasal airway resistance is independent of age and sex.
doi:10.1007/s12070-011-0300-0
PMCID: PMC3477443  PMID: 24294574
Total nasal airflow resistance; Active anterior rhinomanometry; Chattisgarh
2.  The nasal response to exercise and exercise induced bronchoconstriction in normal and asthmatic subjects. 
Thorax  1988;43(11):890-895.
Two studies were carried out to test the hypothesis that the fall and recovery of nasal resistance after exercise in asthmatic and non-asthmatic subjects are related to the development of bronchoconstriction after exercise. In study 1 nasal resistance (posterior rhinomanometry) and specific airway resistance (sRaw) were measured before challenge and one, five, 10 and 30 minutes after four minutes of exhausting legwork exercise in nine asthmatic subjects and nine age matched healthy subjects. One minute after exercise there was a reduction in nasal resistance of 49% (SD 15%) from baseline in the healthy subjects and of 66% (17%) in the asthmatic subjects. This response and the subsequent return of nasal resistance to baseline values did not differ significantly between the two groups despite a substantial difference in the change in sRaw, an increase of 74% (45%) in the asthmatic subjects 10 minutes after exercise, and no change in the non-asthmatic subjects. In study 2, nasal and specific airway resistances were monitored according to the same measurement protocol in six subjects with increased airway reactivity. Subjects exercised on two occasions, wearing a noseclip, once while breathing cold, dry air and once while breathing warm, humid air. The fall in nasal resistance was similar under both conditions (to 47% and 39% of baseline), through sRaw rose only after cold air inhalation (to 172% of baseline). The results indicate that the nasal response to exercise is not related to bronchial obstruction in asthmatic subjects after exercise or to the temperature or humidity of the air inspired through the mouth during exercise.
PMCID: PMC461549  PMID: 3222760
3.  Regional Peak Mucosal Cooling Predicts the Perception of Nasal Patency 
The Laryngoscope  2013;124(3):589-595.
Objective
Nasal obstruction is the principal symptom that drives patients with rhinosinus disease to seek medical treatment. However, patient perception of obstruction often bears little relationship to actual measured physical obstruction of airflow. This lack of an objective clinical tool hinders effective diagnosis and treatment. Previous work has suggested that the perception of nasal patency may involve nasal trigeminal activation by cool inspiratory airflow; we attempt to derive clinically relevant variables following this phenomenon.
Study design
Prospective healthy cohort.
Methods
Twenty-two healthy subjects rated unilateral nasal patency in controlled room air using a visual analog scale, followed by rhinomanometry, acoustic rhinometry and butanol lateralization thresholds (BLT). Each subject then immediately underwent a CT scan, enabling the construction of a “real-time” computational fluid dynamics (CFD) nasal airway model, which was used to simulate nasal mucosa heat loss during steady resting breathing.
Results
Among all measured and computed variables, only CFD-simulated peak heat loss posterior to the nasal vestibule significantly correlated with patency ratings (r=−0.46, p<0.01). Linear discriminant analysis predicted patency categories with 89% success rate, with BLT and rhinomanometric nasal resistance being two additional significant variables. As validation, CFD simulated nasal resistance significantly correlated with rhinomanometrically measured resistance (r=0.41, p<0.01).
Conclusion
These results reveal that our noses are sensing patency via a mechanism involving localized peak nasal mucosal cooling. The analysis provides a strong rationale for combining the individualized CFD with other objective and neurological measures to create a novel clinical tool to diagnose nasal obstruction and to predict and evaluate treatment outcomes.
doi:10.1002/lary.24265
PMCID: PMC3841240  PMID: 23775640
Nasal congestion; nasal obstruction; TRPM8; nasal cooling; cool perception; nasal trigeminal sensitivity
4.  Perceiving Nasal Patency through Mucosal Cooling Rather than Air Temperature or Nasal Resistance 
PLoS ONE  2011;6(10):e24618.
Adequate perception of nasal airflow (i.e., nasal patency) is an important consideration for patients with nasal sinus diseases. The perception of a lack of nasal patency becomes the primary symptom that drives these patients to seek medical treatment. However, clinical assessment of nasal patency remains a challenge because we lack objective measurements that correlate well with what patients perceive.The current study examined factors that may influence perceived patency, including air temperature, humidity, mucosal cooling, nasal resistance, and trigeminal sensitivity. Forty-four healthy subjects rated nasal patency while sampling air from three facial exposure boxes that were ventilated with untreated room air, cold air, and dry air, respectively. In all conditions, air temperature and relative humidity inside each box were recorded with sensors connected to a computer. Nasal resistance and minimum airway cross-sectional area (MCA) were measured using rhinomanometry and acoustic rhinometry, respectively. General trigeminal sensitivity was assessed through lateralization thresholds to butanol. No significant correlation was found between perceived patency and nasal resistance or MCA. In contrast, air temperature, humidity, and butanol threshold combined significantly contributed to the ratings of patency, with mucosal cooling (heat loss) being the most heavily weighted predictor. Air humidity significantly influences perceived patency, suggesting that mucosal cooling rather than air temperature alone provides the trigeminal sensation that results in perception of patency. The dynamic cooling between the airstream and the mucosal wall may be quantified experimentally or computationally and could potentially lead to a new clinical evaluation tool.
doi:10.1371/journal.pone.0024618
PMCID: PMC3192719  PMID: 22022361
5.  Acoustic rhinometry in rhinological practice: discussion paper. 
Acoustic rhinometry is a new technique which evaluates nasal obstruction by analysing reflections of a sound pulse introduced via the nostrils. The technique is rapid, reproducible, non-invasive and requires minimal cooperation from the subject. Unlike rhinomanometry it does not require airflow. A graph of nasal cross-sectional area as a function of distance from the nostril is produced, from which several area and volume estimates of the nasal cavity can be derived. The reliability of the method is greatest in the anterior nasal cavity, which is the site of the nasal valve. We have applied the technique to the study of normal nasal physiology in adults and children and to a range of pathological conditions. The role of acoustic rhinometry in diagnosis is somewhat limited compared to nasal endoscopy, but it is useful for nasal challenge and for quantifying nasal obstruction. Monitoring of medical and surgical therapy is a more promising application. In future, acoustic rhinometry is likely to be of particular help in evaluating childhood nasal obstruction, as it is well tolerated by children as young as 3 years old-a group of patients to whom objective tests have hitherto been difficult to apply.
Images
PMCID: PMC1294654  PMID: 8046730
6.  Nasal valve surgery 
SUMMARY
The nasal valve region plays a key role in nasal breathing. In the international literature, a variety of techniques have been described to rectify nasal valve compromise, but based on the present evidence it is impossible to counsel a patient as to which technique is most effective. The aim of this study was to evaluate the results of surgery of the nasal valve through a hemitransfixion incision objectively with nasal endoscopy and rhinomanometry. The study group consisted of 54 males and 15 females with a mean age of 41.8 ± 14.4 years, (range: 21-72 years). After a mean follow-up of 8 ± 4.1 months, nasal endoscopy demonstrated the favourable effects of surgical treatment with a normalization of the nasal valve angles. Only 5 patients showed persistent nasal valve stenosis, and were scheduled for revision surgery. Preoperatively, total decongested inspiratory NARs were 0.245 ± 0.091 Pa/cm3/s and decreased significantly after the operation (p < 0.0005) to 0.154 ± 0.059 Pa/cm3/s. Similarly, preoperatively total decongested expiratory NARs were 0.188 ± 0.068 Pa/cm3/s and decreased significantly after the operation (p < 0.0005) to 0.142 ± 0.059 Pa/cm3/s. Moreover, total dilated inspiratory and expiratory NARs resulted significantly (p < 0.0005) lower than the preoperatively total decongested NARs, with a mean value of 0.120 ± 0.059 Pa/cm3/s and 0.102 ± 0.057 Pa/cm3/s, respectively. Statistical analysis did not reveal any influence of sex and age in rhinomanometric measurements. Hemitransfixion incision allowed a wide access to the whole valve area for inspection and correction of the various components. Rhinomanometry, performed in a decongested condition and after dilation test, was thus a useful diagnostic tool for the preoperative diagnosis of nasal valve obstruction and permitted to assess quantitatively the favourable effect of surgical procedures.
PMCID: PMC3709521  PMID: 23853416
Rhinoplasty; Nasal valve; Rhinomanometry
7.  A Swiss 3T3 variant cell line resistant to the effects of tumor promoters cannot be transformed by src. 
Molecular and Cellular Biology  1990;10(8):4155-4162.
To study the relationship between oncogenesis by v-src and normal cellular signalling pathways, we determined the effects of v-src on 3T3-TNR9 cells, a Swiss 3T3 variant which does not respond mitogenically to tumor promoters such as 12-O-tetradecanoyl-phorbol-13-acetate (TPA). We found that src was unable to transform these variant cells, whether the oncogene was introduced by infection with a murine retrovirus vector or by transfection with plasmid DNA. 3T3-TNR9 cells were not inherently resistant to transformation, since infection with similar recombinant retroviruses containing either v-ras or v-abl did induce transformation. Further analysis of Swiss 3T3 and 3T3-TNR9 cell populations infected with the v-src-containing retrovirus revealed that although the amount of v-src DNA in each was approximately the same, the level of the v-src message and protein and the overall level of phosphotyrosine expressed in the infected variants was much less than in infected parental cells. Cotransfection experiments using separate v-src and neo plasmids revealed a decrease in the number of G418-resistant colonies when transfections of TNR9 cells occurred in the presence of the src-containing plasmid, suggesting a growth inhibitory effect of v-src on 3T3-TNR9 cells, as has also been found for TPA itself. Since v-src cannot transform this variant cell line, which does not respond mitogenically to the protein kinase C agonist TPA, we suggest that src makes use of the protein kinase C pathway as part of its signalling activities.
Images
PMCID: PMC360942  PMID: 2115120
8.  Role of Surgery in Isolated Concha Bullosa 
Objective:
To study the benefit of surgery in different types of isolated concha bullosa.
Design:
Prospective case series.
Setting:
Academic Medical Center.
Patients:
Forty seven symptomatic patients complaining of nasal congestion and block, headache and facial pain having concha bullosa without any other sinonasal finding. Their conchae bullosa were classified as lamellar, bulbous and extensive concha bullosa. They were subjected to endoscopic operation.
Main outcome measures:
Subjective evaluation of postoperative improvement of sinonasal symptoms and objective pre- and postoperative measurement of total nasal resistance by rhinomanometry.
Results:
Two patients (25%) of lamellar type showed complete improvement, 5 patients (62.5%) showed partial improvement and 1 patient (12.5%) showed no improvement. Regarding bulbous type, 16 patients (72.72%) showed complete improvement, 6 patients (27.28%) showed partial improvement and no patient (0%) showed no improvement. Regarding extensive type, 15 (88.24%) patients showed complete improvement, 2 patients (11.76%) showed partial improvement and no patient (0%) showed no improvement. The total nasal resistance was 0.25 Pa/cm3 per second postoperatively compared with 0.37 Pa/cm3 per second preoperatively in patients having lamellar type; 0.28 Pa/cm3 per second postoperatively compared with 0.71 Pa/cm3 per second preoperatively in patients having bulbous type; and 0.27 Pa/cm3 per second postoperatively compared with 0.67 Pa/cm3 per second preoperatively in patients having extensive type.
Conclusions:
With proper patient selection, the operative management is of great value in relieving the sinonasal symptoms in patients having isolated Concha bullosa. This will be more obvious in certain types as bulbous and extensive types especially of large sizes.
doi:10.4137/CMENT.S6769
PMCID: PMC3783290  PMID: 24179401
concha; bullosa; rhinomanometry; lamellar; bulbous and extensive
9.  Assessment of Septoplasty Effectiveness using Acoustic Rhinometry and Rhinomanometry 
Introduction:
Septal deviation is the chief cause of chronic nasal obstruction. In order to treat such cases, nasal septoplasty surgery is usually performed based on patient complaints and a surgeon's examination, both of which are subjective. This study aims at using the objective parameters of acoustic rhinometry and rhinomanometry to evaluate the effectiveness of septoplasty surgery.
Materials and Methods:
A prospective study was performed in 30 candidate patients for septoplasty surgery. Acoustic rhinometry and rhinomanometry tests were performed on all patients both before and 3 months after the operation. The symptom recovery rate was recorded according to the patient's statements and anterior rhinoscopic examinations 3 months after surgery. Data were analyzed using a t-test and chi-square tests in a SPSS package.
Results:
A total of 26 of 30 patients returned for a post–procedure follow-up examination after 3 months. Patients were aged from 18 to 32 years (average, 25 years). In total 69.2% (18 patients) were satisfied with the results of the procedure. In addition, rhinomanometry resulted in a decrease in general nasal resistance if patients used decongestants (P=0.03). However, the decrease was not significant before the use of decongestants (P=0.12). Furthermore, according to the results from acoustic rhinomanometry, there was an increase in the nasal cross-sectional area on both the narrow and wide sides after the operation (P<0.05), although this increase was not so notable in the narrower side after using decongestants. There was, however, no significant relationship between the results from the objective tests and the patient's symptoms or clinical examinations (P>0.05).
Conclusion:
The findings of this study show that although the objective tests confirm an improvement in general nasal resistance and an increase in the nasal cross-sectional area after surgery, no unambiguous relationship between the patient's symptoms and the clinical examinations is observed. Therefore, such objective tests do not prove to be sufficient diagnostic criteria for the effectiveness of septoplasty.
PMCID: PMC3846266  PMID: 24303423
Acoustic rhinometry; Nasal airway obstruction; Nasal septum; Rhinomanometry
10.  Response of the nose to exercise in healthy subjects and in patients with rhinitis and asthma. 
Thorax  1994;49(2):128-132.
BACKGROUND--Although the nose and the bronchi are both involved in the process of regulating respiratory heat exchange, thermal changes may precipitate airway obstruction during exercise but rarely cause nasal obstruction in patients with rhinitis. The cause of the different response of the nose and bronchial tree has hardly been investigated. This study was performed to assess the response of the nose during exercise in the presence of rhinitis, asthma, and in normal controls. METHODS--Ten healthy subjects (group 1), 15 patients with asthma and rhinitis (group 2), 10 with rhinitis only (group 3), and 11 with asthma only (group 4) were included in the study. Exercise was performed on a bicycle ergometer for six minutes, reaching a heart rate of 80% of predicted. Bronchial and nasal responses were measured by forced expiratory volume in one second (FEV1) and posterior rhinomanometry, respectively. A drop in the FEV1 of 20% or more was considered a positive exercise induced asthma challenge test. RESULTS--Heart rate and ventilation increased by a similar proportion in the four groups. The FEV1 significantly decreased in asthmatic patients (groups 2 and 4) but it did not change in healthy subjects (group 1) or in those with rhinitis (group 3). Thirteen asthmatic patients developed exercise induced asthma. Nasal patency increased with exercise by a similar proportion in all groups, and no differences were detected between those with rhinitis (groups 2 and 3) and those without (groups 1 and 4). Nasal patency had returned to basal values at 25 minutes after completion of exercise in the four groups. The nose of patients with exercise induced asthma, however, remained significantly more patent than in patients without exercise induced asthma between 10 and 30 minutes after exercise. CONCLUSIONS--These results suggest that the nose responds differently from the bronchi during exercise induced airway obstruction: whereas the bronchial tree responds by becoming narrowed, the nose becomes more patent. These findings suggest that the mechanisms regulating the response of the nose to exercise are different from those involved in the response of the bronchial tree.
PMCID: PMC474323  PMID: 8128401
11.  Work related impairment of nasal function in Swedish woodwork teachers. 
OBJECTIVE: To study the relation between exposure and nasal function in woodwork teachers. METHODS: 39 selected woodwork teachers employed full time and 32 control subjects (other school personnel) were examined at the beginning and at the end of a working week with symptom rating, nose and throat inspection, rhinomanometry, nasal mucociliary clearance test, and a smell identification test. During one working day of the same week climate, dust and terpene concentrations were measured in all 39 schools. RESULTS: The ventilation rate was highest in rooms with mechanical ventilation. Range of total dust (personally sampled) was 0.12-1.18 mg/m3, respirable dust 0.02-0.21 mg/m3, and terpenes (area sampled) 0.02-6.8 mg/m3. In contrast to the control subjects, the woodwork teachers had more nasal symptoms on the Thursday afternoon than on the Monday morning, especially those working in rooms without mechanical ventilation. Their mucociliary clearance worsened during the week (mean increase 4 min, P < 0.001). A small impairment of olfactory function was also found, but their rhinomanometric values did not change significantly. Nasal symptoms correlated weakly with the percentage of respirable dust in the total dust. Otherwise there were no significant dose-effect relations between measured dust or terpene concentrations and nasal tests. CONCLUSIONS: The woodwork teachers had mainly reversible nasal complaints, impaired nasal mucociliary clearance and olfactory function related to the work environment, with dust concentrations below the Swedish threshold limit value of 2 mg/m3.
PMCID: PMC1128423  PMID: 8777447
12.  Role of rhinomanometry to assess nasal airflow and resistance in patients undergoing septoplasty 
Nasal obstruction is a common symptom. Rhinomanometry is a tool to objectively assess the nasal airway. A prospective study was undertaken to assess the nasal airflow and nasal resistance in 25 patients of deviated nasal septum undergoing septoplasty using rhinomanometry preoperatively and postoperatively. Rhinomanometric improvement in nasal airflow and decreased nasal resistance were found in 88% patients after surgery.
doi:10.1007/s12070-007-0119-x
PMCID: PMC3450507  PMID: 23120521
Nasal obstruction; Rhinomanometry; Nas al resistance; Nasal airflow; Septoplasty
13.  Predictive role of nasal functionality tests in the evaluation of patients before nocturnal polysomnographic recording 
SUMMARY
Obstructive sleep apnoea syndrome is a disease characterized by a collapse of the pharyngeal airway resulting in repeated episodes of airflow cessation, oxygen desaturation, and sleep disruption. It is a common disorder affecting at least 2-4% of the adult population. The role of nasal resistance in the pathogenesis of sleep disordered breathing and sleep apnoea has not been completely clarified. Aim of the present study was to establish whether nasal resistance and nasal volumes, measured by means of Active Anterior Rhinomanometry and Acoustic Rhinometry together with Muco-Ciliary Transport time play a positive predictive role in the evaluation of Obstructive sleep apnoea syndrome patients before running a nocturnal polysomnographic recording. A retrospective study was performed analysing 223 patients referred for suspected Obstructive sleep apnoea syndrome. All patients were submitted to complete otorhinolaryngological evaluation and underwent nocturnal polysomnography. On the basis of polysomnographic data analysis, the apnoea-hypopnoea index and snoring index, patients were classified into two groups: Group 1 (110/223 patients) with a diagnosis of mild-moderate Obstructive sleep apnoea syndrome (apnoea-hypopnoea index < 30) and Group 2 (113/223 patients) affected by snoring without associated hypoxaemia/hypercapnia. A control group of 76 subjects, not complaining of sleep disorders and free from nasal symptoms was also selected. The results showed, in all the snoring and Obstructive sleep apnoea syndrome patients, total nasal resistance and increased Muco-Ciliary Transport time compared to standard values. Furthermore, the apnoea-hypopnoea index was significantly higher in patients with higher nasal resistence and significantly different between the groups. These results allow us to propose the simultaneous evaluation of nasal functions by Active Anterior Rhinomanometry, Acoustic Rhinometry, and Muco-Ciliary Transport time in the selection of patients undergoing polysomnography.
PMCID: PMC3203739  PMID: 22064751
Sleep respiratory disorders; Obstructive sleep apnoea syndrome; Nasal functionality tests; Polysomnography
14.  Reference values for respiratory system impedance using impulse oscillometry in healthy preschool children 
Korean Journal of Pediatrics  2011;54(2):64-68.
Purpose
The normal values for lung resistance and lung capacity of children, as determined by impulse oscillometry (IOS), are different for children of different ethnicities. However, reference values there is no available reference value for Korean preschool children have yet to be determined. The aim of the present study was to determine the normal ranges of IOS parameters in Korean preschool children.
Methods
A total of 133 healthy Korean preschool children were selected from 639 children (aged 3 to 6 years) who attended kindergarten in Seongnam, Gyeonggi province, Korea. Healthy children were defined according to the European Respiratory Society (ERS) criteria. All subjects underwent lung function tests using IOS. The relationships between IOS value (respiratory resistance (Rrs) and reactance (Xrs) at 5 and 10 Hz and resonance frequency (RF)) and age, height, and weight were analyzed by simple linear and multiple linear regression analyses.
Results
The IOS success rate was 89.5%, yielding data on 119 children. Linear regression identified height as the best predictor of Rrs and Xrs. Using stepwise multiple linear regressions based on age, height, and weight, we determined regression equations and coefficients of determination (R2) for boys (Rrs5=1.934-0.009×Height, R2=12.1%; Xrs5=0.774+0.006×Height-0.002×Age, R2=20.2% and for girls (Rrs5=2.201-0.012×Height, R2=18.2%; Xrs5=-0.674+0.004×Height, R2=10.5%).
Conclusion
This study provides reference values for IOS measurements of normal Korean preschool children. These provide a basis for the diagnosis and monitoring of preschool children with a variety of respiratory diseases.
doi:10.3345/kjp.2011.54.2.64
PMCID: PMC3077503  PMID: 21503199
Impulse oscillation system; Reference values; Airway resistance; Preschool children
15.  Effect of aspirin on nasal resistance to airflow. 
The effect of aspirin on nasal resistance to airflow was investigated by rhinomanometry in 25 healthy subjects before and after ingestion of aspirin or vitamin C in a double blind crossover trial. Aspirin caused a significant increase in nasal resistance compared with vitamin C. The effect of aspirin may be due to its inhibition of the synthesis of prostaglandins.
PMCID: PMC1418864  PMID: 3921141
16.  Nasal Anthropometry on Facial Computed Tomography Scans for Rhinoplasty in Koreans 
Archives of Plastic Surgery  2013;40(5):610-615.
Background
Cephalometric analysis is essential for planning treatment in maxillofacial and aesthetic facial surgery. Although photometric analysis of the Korean nose has been attempted in the past, anthropometry of the deeper nasal structures in the same population based on computerized tomography (CT) has not been published. We therefore measured three anthropometric parameters of the nose on CT scans in our clinical series of patients.
Methods
We conducted the current retrospective study of a total of 100 patients (n=100) who underwent a CT-guided radiological measurement at our institution during a period ranging from January of 2008 to August of 2010. In these patients, we took three anthropometric measurements: the nasofrontal angle, the pyramidal angle, and the linear distance between the nasion and the tip of the nasal bone.
Results
The mean nasofrontal angle was 131.14° in the male patients and 140.70° in the female patients. The mean linear distance between the nasion and the tip of the nasal bone was 21.28 mm and 18.02 mm, respectively. The mean nasal pyramidal angle was 112.89° and 103.25° at the level of the nasal root, 117.49° and 115.60° at the middle level of the nasal bone, and 127.99° and 125.04° at the level of the tip of the nasal bone, respectively.
Conclusions
In conclusion, our data will be helpful in the preparation of silicone implants for augmentation and/or corrective rhinoplasty in ethnic Korean people.
doi:10.5999/aps.2013.40.5.610
PMCID: PMC3785598  PMID: 24086818
Anthropometry; Nose; Rhinoplasty; Korea
17.  243 Peak Inspiratory Flow Rate is More Sensitive Than Acoustic Rhinometry or Rhinomanometry in Detecting Nasal Obstruction Using the Allergen Challenge Chamber 
The World Allergy Organization Journal  2012;5(Suppl 2):S96-S97.
Background
We prepared an allergen challenge chamber (ACC) which facilitates quantitative pollen challenge at any time, and, so, the acquisition of objective data. The aim of this study was to evaluate peak nasal inspiratory flow rate (PIFR) as an endpoint during allergen challenge and compare this with rhinomanometry (Rhino) and acoustic rhinometry (AR).
Methods
The study was conducted in November, which is not in pollen season. Subjects were exposed to Japanese cedar pollen at a concentration of 50,000 counts/m3in ACC for 120 minutes each day for 2 days. Subject recorded nasal symptoms before challenge and every 15 minutes after challenge initiation. Nasal symptoms (sneezing frequency, nasal blowing frequency, nasal obstruction) were recorded before challenge and every 15 minutes after challenge initiation. For the evaluation of nasal obstruction, we used visual analog scales (VASs); subjects marked a site on a 10-cm line corresponding to the symptom severity on which absence of symptoms was designated as 0 and worst imaginable symptom as 10. PIFR was measured using an In-check flow meter and nasal resistance was measured using Rhino. The cross-sectional area in the nasal cavity was also measured using AR before and after challenge as an indicator of nasal obstruction.
Results
When the volunteers with cedar pollinosis were exposed to cedar pollen in ACC, pollinosis symptoms were induced significantly. Changes in the 3 symptoms (sneezing frequency, nose-blowing frequency, nasal obstruction) were investigated before and after challenges on 2 consecutive days. No significant symptoms were induced on the first day of challenge in the non-pollen season. However, each of the 3 symptoms became more severe with second day of challenge, and a significant increase was seen in cumulative values by the second day. In terms of the allergen challenge test, we found a significant correlation between nasal obstruction symptom (VAS) and PIFR, but not AR and Rhino.
Conclusions
PIFR after allergen challenge is more sensitive than AR or Rhino in detecting nasal obstruction using the allergen challenge chamber.
doi:10.1097/01.WOX.0000412000.07996.50
PMCID: PMC3512642
18.  145 Rhinitis: Where is the Biofilm? 
Background
Several ultramicroscopic studies have confirmed the presence of biofilms in ENT diseases, such as chronic rhinosinusitis, nasal polyposis or adenoid hypertrophy. Recently, it has been reported that light microscopy nasal cytology can identify biofilms, which appear as cyan-stained “Infectious Spots.”
Methods
Subjects suffering from a wide spectrum of nasal disorders, after a detailed clinical history and ENT examination, underwent nasal fibroendoscopy, skin prick test, rhinomanometry and nasal cytology.
Results
1410 subjects were studied. The infectious spot was present in 107 of them (7.6%) patients; this percentage reached 55.4% in 193 patients who had clear cytologic signs of infectious rhinitis. Biofilms were largely more frequent in patients with adenoid hypertrophy (57.4%), followed by nasal polyposis (24%), chronic rhinosinusitis (9.5%) and non-allergic “cellular” rhinitis (7.6%). Nasal cytology was normal in the remaining patients, with no infectous spot detectable. Statistical analysis showed that nasal resistances were significantly higher in presence of biofilms in patients affected by adenoid hypertrophy (P = 0.003), nasal polyposis (P < 0.001), chronic rhinosinusitis (P = 0.018) and septal deviation (P = 0.001).
Conclusions
The results demonstrate that biofilms are not present only in infectious rhinopathies, but also in inflammatory and/or immune-mediateddiseases. Biofilms were more frequent in patients with higher degree of nasal obstruction as assessed by nasal endoscopy (grade III and IV adenoids and stage-3 polyposis) and rhinomanometry. Nasal cytology, by allowing the identification of biofilms represents a useful diagnostic tool with promising research implications.
doi:10.1097/01.WOX.0000411890.67395.64
PMCID: PMC3512753
19.  Activity of hypertonic solution with Silver and Potassium Sucrose Octasulfate on nasal symptoms in obstructive rhinopathy with and without rhinosinusitis 
SpringerPlus  2013;2:668.
Background
Nasal obstruction is a primary symptom of common upper respiratory tract disorders. In clinical practice nasal saline solutions are recommended for the cleansing of nasal cavities and relieving nasal symptoms.
Methods
55 patients (aged 25–70 years) suffering from obstructive rhinopathy, with nasal obstruction/congestion of moderate severity persistent since at least 10 days in advance of recruitment with/without rhinosinusitis was randomly treated with an hypertonic solution composed by Silver Sucrose Octasulfate and Potassium Sucrose Octasulfate (SILSOS) or isotonic solution for 20 days.
At baseline (T0), ten days (T10) and twenty days (T20) after SILSOS treatment, study participants were evaluated subjectively with VAS and SNOT-22, objectively by Active Anterior Rhinomanometry (AAR) and MCC/MCTt determination. Forty-four patients were followed-up 30 days after the end of treatment by a phone interview.
Results
The AAR analysis showed in SILSOS group a significantly (p < 0.05) ameliorated in expiratory flow, at T0-T10 and T0-T20. No improvement in MCTt was observed over the 20 days study period. The mean values MCC of significantly improved at T20 (p < 0.05). VAS total score showed improvement along all time-intervals. Nasal obstruction was back 30 days after the end of treatment with SILSOS in only 3 patients and reported to be in a mild form.
Conclusions
The obtained results show that SILSOS hyper has added to the mechanical action of removal of secretions a specific decongestant and antiseptic effect lasting longer after the end of treatment. Could help to fluidize thick mucus, improve respiration and promote resolution of symptoms, preventing pathogens adhesion to nasal mucosa.
doi:10.1186/2193-1801-2-668
PMCID: PMC3967734
Nasal obstruction; VAS; SNOT-22; Rhinopathy; Silver sucrose octasulfate; Potassium sucrose octasulfate
20.  Impacts of Fluid Dynamics Simulation in Study of Nasal Airflow Physiology and Pathophysiology in Realistic Human Three-Dimensional Nose Models 
During the past decades, numerous computational fluid dynamics (CFD) studies, constructed from CT or MRI images, have simulated human nasal models. As compared to rhinomanometry and acoustic rhinometry, which provide quantitative information only of nasal airflow, resistance, and cross sectional areas, CFD enables additional measurements of airflow passing through the nasal cavity that help visualize the physiologic impact of alterations in intranasal structures. Therefore, it becomes possible to quantitatively measure, and visually appreciate, the airflow pattern (laminar or turbulent), velocity, pressure, wall shear stress, particle deposition, and temperature changes at different flow rates, in different parts of the nasal cavity. The effects of both existing anatomical factors, as well as post-operative changes, can be assessed. With recent improvements in CFD technology and computing power, there is a promising future for CFD to become a useful tool in planning, predicting, and evaluating outcomes of nasal surgery. This review discusses the possibilities and potential impacts, as well as technical limitations, of using CFD simulation to better understand nasal airflow physiology.
doi:10.3342/ceo.2012.5.4.181
PMCID: PMC3506767  PMID: 23205221
Computational fluid dynamics; Nose models; Nasal airflow dynamics; Airflow physiology and pathophysiology
21.  147 3-D Visualization of the Anti-Obstructive Effect of Levocetirizine 
The World Allergy Organization Journal  2012;5(Suppl 2):S65-S66.
Background
Our investigation aimed to visualize the 3-D spatial distribution of nasal cavity mucosal swelling under levocetirizine prophylactic treatment on exposure to allergens. This study made use of standard rhinologic diagnostics such as rhinomanometry and acoustic rhinometry, as well as 24 hours rhinometry and magnetic resonance imaging (MRI).
Methods
A suitable test subject with a history of allergic rhinitis was identified during the symptom-free interval after the pollen season when she showed signs of “minimal persistent inflammation,” consisting of pronounced reaction to nasal challenge with allergens. Provocation with birch pollen caused moderate symptoms of allergic rhinitis. Nasal provocation tests were performed before and after 2 and 5 weeks of treatment with levocetirizine 5 mg OD. Long-term rhinometry was carried out to detect the progress of the nasal cycle and relative flow variances over 24 hours. Flexible air tubes required for this new procedure made it possible to quantify relative pressure changes. High resolution MRI was also used to capture, visualize, and process the geometrical data of the nasal cavity immediately before and after the challenge tests. Based upon the MRI data, we computed the nasal airflow using a computational fluid dynamics (CFD) nasal model to visualize intranasal pressure and flow. Rhinomanometry and acoustic rhinometry were performed to validate the results.
Results
After 36 days of treatment with levocetirizine, a 16% improvement in the nasal flow relative to baseline and an increase by 3.4 cm3 of the total nasal baseline volume were documented as compared to the allergen challenge of the untreated case. 3-D images illustrated that treatment inhibited the allergen provocation effects on nasal airflow and normalised nasal flow velocity and pressure, including in the olfactory region.
Conclusions
Besides improving the nasal airflow to an almost normal pattern, levocetirizine also helps prevents the patient from having an allergic response, even 24 hours after last drug intake. Furthermore, it can improve olfaction by restoring airflow to the olfactory region.
doi:10.1097/01.WOX.0000411892.75019.4c
PMCID: PMC3512940
22.  Nasal and lung function in competitive swimmers 
Summary
Nasal and sinusal complaints are considered common among swimmers. Aim of the present study was to evaluate the nasal and bronchial functions, before and after swimming, and the relationship between nasal resistances and FEV1 in competitive swimmers. A group of 30 competitive swimmers were examined: spirometry and nasal respiratory tests were carried out before and after swimming. Moreover, both the competitive swimmers and the 150 visitors of a swimming pool were asked to complete a specific questionnaire. In this questionnaire, 18% of the population reported nasal-sinusal symptoms after swimming. The differences between nasal volumes and resistances before and after swimming were not statistically significant. Nasal patency increased or remained unchanged in 21/30 athletes. The variations in FEV1 were not statistically significant. In conclusion, results showed that swimming is able to increase nasal patency or to leave it unchanged. Temporary worsening of the nasal patency was observed in only a few hyper-reactive patients. In the whole group, no variations, at bronchial level, were found.
PMCID: PMC2815359  PMID: 20140159
Nose; Nasal physiology; Swimming pool; Chlorine
23.  Nasal nitric oxide in a random sample of adults and its relationship to sensitization, cat allergen, rhinitis, and ambient nitric oxide 
Background:
There is conflicting evidence whether nasal nitric oxide (NO) is associated with current rhinitis and with other possible predictors. Most studies have been performed in clinical cohorts and there is a lack of studies based on a general population sample. The aim of the present study was to investigate predictors for levels of nasal nitric oxide (NO) in a general population.
Methods:
The population consisted of 357 subjects from Gothenburg participating in the follow-up of the European Respiratory Health Survey in 1999–2001. All subjects completed an extensive respiratory questionnaire. Nasal NO was measured from one nostril at a time with a sampling rate of 50 mL/s for 16 seconds and the nasal NO concentration was determined as the mean value within the plateau phase. Mattress dust samples were collected for cats and mites in a subsample of subjects. Ambient and exhaled NO was also measured. The predictors for nasal NO were analyzed in multiple linear regression models.
Results:
There was no relation between the levels of nasal NO and reporting current rhinitis. Nasal NO was significantly increased among those with high levels of IgE against cats and current smokers had significantly lower nasal NO. There was also a positive association between ambient NO and nasal NO. There were no significant associations between nasal NO and sex, age, or height, or between nasal NO and measured levels of cat antigen.
Conclusion:
In this general population sample we found no relation between current rhinitis and nasal NO levels. There was a clear association between sensitization to cat and nasal NO, but there was no relation to current exposure to cat allergen. Our data support that nasal NO has a limited value in monitoring upper airway inflammation.
doi:10.2500/ajra.2012.26.3777
PMCID: PMC3906512  PMID: 22643936
Allergic rhinitis; epidemiology; FENO; nasal nitric oxide; nNO; rhinitis; sensitization
24.  The Hypertonic Environment Differentially Regulates Wild-type CFTR and TNR-CFTR Chloride Channels 
Cellular Physiology and Biochemistry  2010;26(4-5):577-586.
This study tested the hypotheses that the hypertonic environment of the renal medulla regulates the expression of cystic fibrosis transmembrane conductance regulator protein (CFTR) and its natural splice variant, TNR-CFTR. To accomplish this, Madin- Darby canine kidney (MDCK) stable cell lines expressing TNR-CFTR or CFTR were used. The cells were treated with hypertonic medium made with either NaCl or urea or sucrose (480 mOsm/kg or 560 mOsm/kg) to mimic the tonicity of the renal medulla environment. Western blot data showed that CFTR and TNR-CFTR total cell protein is increased by hypertonic medium, but using the surface biotinylation technique, only CFTR was found to be increased in cell plasma membrane. Confocal microscopy showed TNR-CFTR localization primarily at the endoplasmic reticulum and plasma membrane. In conclusion, CFTR and TNR-CFTR have different patterns of distribution in MDCK cells and they are modulated by a hypertonic environment, suggesting their physiological importance in renal medulla.
PMCID: PMC3048939  PMID: 21063095
CFTR; TNR-CFTR; Sodium chloride; Urea Sucrose; MDCK cells; Hypertonic environment Plasma membrane
25.  Normative Measurements of Grip and Pinch Strengths of 21st Century Korean Population 
Archives of Plastic Surgery  2013;40(1):52-56.
Background
Measuring grip and pinch strength is an important part of hand injury evaluation. Currently, there are no standardized values of normal grip and pinch strength among the Korean population, and lack of such data prevents objective evaluation of post-surgical recovery in strength. This study was designed to establish the normal values of grip and pinch strength among the healthy Korean population and to identify any dependent variables affecting grip and pinch strength.
Methods
A cross-sectional study was carried out. The inclusion criterion was being a healthy Korean person without a previous history of hand trauma. The grip strength was measured using a Jamar dynamometer. Pulp and key pinch strength were measured with a hydraulic pinch gauge. Intra-individual and inter-individual variations in these variables were analyzed in a standardized statistical manner.
Results
There were a total of 336 healthy participants between 13 and 77 years of age. As would be expected in any given population, the mean grip and pinch strength was greater in the right hand than the left. Male participants (137) showed mean strengths greater than female participants (199) when adjusted for age. Among the male participants, anthropometric variables correlated positively with grip strength, but no such correlations were identifiable in female participants in a statistically significant way.
Conclusions
Objective measurements of hand strength are an important component of hand injury evaluation, and population-specific normative data are essential for clinical and research purposes. This study reports updated normative hand strengths of the South Korean population in the 21st century.
doi:10.5999/aps.2013.40.1.52
PMCID: PMC3556534  PMID: 23362480
Hand strength; Pinch strength; Muscle dynamometer; Korean population; Demographic transition

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