Relationship Between Nasal Cycle, Nasal Symptoms and Nasal Cytology

Background The nasal cycle is the spontaneous congestion and decongestion of nasal mucosa that happens during the day. Classically, 4 types of nasal cycle patterns have been described: (1) classic, (2) parallel, (3) irregular, and (4) acyclic. Hypothalamus has been considered as the central regulator even if several external factors may influence its activity. Objective The aim of the study was to evaluate the presence of a correlation between nasal cycle pattern, nasal cytology and nasal symptoms. Methods Thirty healthy volunteers have been enrolled in the study. All subjects completed a Sino-Nasal Outcome Test-22 questionnaire and a Visual Analog Scale (VAS) for nasal obstruction. The nasal cycle was studied by means of peak nasal inspiratory flow. Nasal cytology has been used to evaluate the presence of local nasal inflammation. Results Nineteen subjects showed a parallel nasal cycle pattern, while 11 showed a regular one. A parallel pattern was present in 60% of asymptomatic subjects and in 67% of the symptomatic one ( P = 1). VAS for nasal obstruction did not show a significant difference between the 2 patterns of the nasal cycle ( P = .398). Seventeen subjects had a normal rhinocytogram, while 13 volunteers showed a neutrophilic rhinitis; 53.8% of the subjects with a neutrophilic rhinitis showed a parallel pattern, while the remaining 46.2% had a regular one. In the case of a normal cytology, 70.6% of the volunteers had a parallel pattern and 29.4% had a regular one. Differences between the 2 groups were not statistically significant ( P = .575). Conclusion Rhinitis with neutrophils seems to not influence the nasal cycle pattern. Based on the present results, the pattern of nasal cycle does not influence subjective nasal obstruction sensation.

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Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses

Rhinology Journal ◽

10.4193/rhino13.037 ◽

2014 ◽

Vol 52 (1) ◽

pp. 25-30

Author(s):

G. Ottaviano ◽

V. Lund ◽

E. Nardello ◽

B. Scarpa ◽

G. Frasson ◽

...

Keyword(s):

Nasal Obstruction ◽

Healthy Subjects ◽

Roc Analysis ◽

Operating Characteristic ◽

The Other ◽

Nasal Patency ◽

Easy Method ◽

Nasal Blockage ◽

Nasal Symptoms ◽

Peak Nasal Inspiratory Flow

Aims: Peak Nasal Inspiratory Flow (PNIF) is an easy method to assess nasal patency. Normative unilateral PNIF data in adults have been proposed. The study purpose was to compare PNIF and unilateral PNIF values to total and unilateral nasal resistances measured by anterior active rhinomanometry (AAR) in subjects with and without nasal obstruction to see whether unilateral PNIFis sensitive to detect nasal obstruction. Methods and results: Measurements of PNIF, unilateral PNIF and AAR were performed in 125 volunteers. Seventy of them were healthy subjects not complaining of nasal symptoms and entered into the study as the'normal' group. The other group consisted of fifty-five symptomatic subjects.Data were analysed to show the correlation between PNIF, unilateral PNIF and nasal resistances. The ability of PNIF and AAR in predicting pathologies were compared by receiver operating characteristic (ROC) analysis indicating that PNIF and AAR have a similar and significant power to discriminate pathologic from healthy subjects. Conclusion: The measurement of unilateral PNIF could be a helpful method to support the diagnosis of nasal blockage also in those cases with single nostril obstruction, but, in cases of doubt, AAR should also be performed to improve diagnostic accuracy.

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Are measurements of peak nasal flow useful for evaluating nasal obstruction in patients with allergic rhinitis?

Rhinology Journal ◽

10.4193/rhino14.048 ◽

2015 ◽

Vol 53 (2) ◽

pp. 160-166

Author(s):

Gardenia Maria Martins de Oliveira ◽

Jose Angelo Rizzo ◽

Paulo Augusto Moreira Camargos ◽

Emanuel Savio Cavalcanti Sarinho

Keyword(s):

Allergic Rhinitis ◽

Nasal Obstruction ◽

Inverse Correlation ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Subjective Evaluations ◽

Nasal Symptoms ◽

Nasal Flow ◽

Peak Nasal Inspiratory Flow

Background: Nasal obstruction is one of the most bothering allergic rhinitis (AR) symptoms and there is a need for objective parameters to complement clinical evaluation due to blunted perception in many patients. In this study we compare measures of peak nasal inspiratory flow (PNIF) and peak nasal expiratory flow (PNEF) in patients with AR and in individuals without nasal symptoms and correlate them with the perception of nasal obstruction. Methods: A comparative cross-sectional study was conducted in 64 AR patients and 67 individuals without nasal symptoms aged between 16 and 50 years. All subjects had PNIF and PNEF measures and subjective evaluations of nasal obstruction were done through a visual analogue scale (VAS) and a symptoms questionnaire. Results: The results show a lower PNIF and PNEF in AR patients compared to controls. There was no correlation between VAS score and PNIF and PNEF. There was a weak inverse correlation between PNIF and symptoms score. Conclusion: Objective measures of nasal obstruction, especially PNIF, can give useful informations on aspects of the disease different from those obtained from the patient`s perception.

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Blastocystis sp. Carriage and Irritable Bowel Syndrome: Is the Association Already Established?

Biology ◽

10.3390/biology10040340 ◽

2021 ◽

Vol 10 (4) ◽

pp. 340

Author(s):

Fernando Salvador ◽

Beatriz Lobo ◽

Lidia Goterris ◽

Carmen Alonso-Cotoner ◽

Javier Santos ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Microscopic Examination ◽

Parasitic Infection ◽

Diagnostic Technique ◽

Control Group ◽

Cross Sectional ◽

Significant Difference ◽

Blastocystis Sp ◽

Irritable Bowel ◽

Asymptomatic Subjects

Background: The aim of the present study is to describe the occurrence of Blastocystis sp. detection among asymptomatic subjects and patients with irritable bowel syndrome in order to evaluate the potential association between irritable bowel syndrome and the parasitic infection. Methods: Cross-sectional study where adult patients with irritable bowel syndrome diagnosed according to Rome IV criteria were included. A control group was formed by asymptomatic subjects older than 18 years. Exclusion criteria were: immunosuppressive condition or having received any drug with demonstrated activity against Blastocystis sp. within the last 6 months before study inclusion. Epidemiological and clinical information was collected from all included participants. Two stool samples were obtained from all participants: one sample for microscopic examination and one sample for Blastocystis sp. PCR detection. Blastocystis sp. infection was defined by the positivity of any of the diagnostic techniques. Results: Seventy-two participants were included (36 asymptomatic subjects and 36 patients with irritable bowel syndrome). Thirty-five (48.6%) were men, and median age of participants was 34 (IQR 29–49) years. The overall rate of Blastocystis sp. carriage was 27.8% (20/72). The prevalence assessed through microscopic examination was 22.2% (16/72), while the prevalence measured by PCR was 15.3% (11/72). When comparing the presence of Blastocystis sp. between asymptomatic subjects and IBS patients, we did not find any statistically significant difference (36.1% vs. 19.4% respectively, p = 0.114). Conclusions: regarding the occurrence of Blastocystis sp., no differences were found between asymptomatic participants and patients with irritable bowel disease irrespective of the diagnostic technique performed.

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Cold bubble humidification of low-flow oxygen does not prevent acute changes in inflammation and oxidative stress at nasal mucosa

Scientific Reports ◽

10.1038/s41598-021-93837-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lauriana Alves Santana ◽

Suellen Karoline Moreira Bezerra ◽

Beatriz Mangueira Saraiva-Romanholo ◽

Wellington Pereira Yamaguti ◽

Iolanda de Fátima Lopes Calvo Tibério ◽

...

Keyword(s):

Oxidative Stress ◽

Nasal Mucosa ◽

Oxygen Therapy ◽

Mucociliary Clearance ◽

Nasal Cannula ◽

Compressed Air ◽

Low Flow ◽

Cross Sectional ◽

Nasal Symptoms ◽

Nasal Inflammation

AbstractSome clinical situations require the use of oxygen therapy for a few hours without hypoxemia. However, there are no literature reports on the effects of acute oxygen therapy on the nasal mucosa. This study aimed to evaluate the acute effects of cold bubble humidification or dry oxygen on nasal Inflammation, oxidative stress, mucociliary clearance, and nasal symptoms. This is a randomized controlled cross-sectional study in which healthy subjects were randomly allocated into four groups: (1) CA + DRY (n = 8): individuals receiving dry compressed air; (2) OX + DRY (n = 8): individuals receiving dry oxygen therapy; (3) CA + HUMID (n = 7): individuals receiving cold bubbled humidified compressed air; (4) OX + HUMID (n = 8): individuals receiving cold bubbled humidified oxygen therapy. All groups received 3 L per minute (LPM) of the oxygen or compressed air for 1 h and were evaluated: total and differential cells in the nasal lavage fluid (NLF), exhaled nitric oxide (eNO), 8-iso-PGF2α levels, saccharin transit test, nasal symptoms, and humidity of nasal cannula and mucosa. Cold bubble humidification is not able to reduced nasal inflammation, eNO, oxidative stress, mucociliary clearance, and nasal mucosa moisture. However, subjects report improvement of nasal dryness symptoms (P < 0.05). In the conclusion, cold bubble humidification of low flow oxygen therapy via a nasal cannula did not produce any effect on the nasal mucosa and did not attenuate the oxidative stress caused by oxygen. However, it was able to improve nasal symptoms arising from the use of oxygen therapy.

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Nasal Cytology in Radiofrequency Turbinate Volume Reduction

ORL ◽

10.1159/000513629 ◽

2021 ◽

pp. 1-6

Author(s):

Giancarlo Pecorari ◽

Giuseppe Riva ◽

Claudia Bartoli ◽

Mattia Ravera ◽

Valeria Dell’Era ◽

...

Keyword(s):

Allergic Rhinitis ◽

Effective Treatment ◽

Nasal Obstruction ◽

Nasal Mucosa ◽

Inferior Turbinate ◽

Volume Reduction ◽

Nonallergic Rhinitis ◽

Turbinate Hypertrophy ◽

Nasal Cytology ◽

Rhinitis Medicamentosa

Introduction: Radiofrequency turbinate volume reduction (RFTVR) is an effective treatment of inferior turbinate hypertrophy. RFTVR can reduce epithelial cell alterations in nasal mucosa. The aim of this observational study was to evaluate the effects of RFTVR on nasal obstruction and cytology, stratifying for different types of rhinitis. Methods: Nasal cytology and subjective nasal obstruction were evaluated on 113 patients before RFTVR (T0) and after 3 months (T1). The patients were divided into groups on the basis of the underlying disease: allergic rhinitis, nonallergic rhinitis, rhinitis medicamentosa, and other diseases (e.g., hormonal-based turbinate hypertrophy). Results: Nasal cytology at T0 identified 42 patients with allergic rhinitis, 40 with nonallergic rhinitis, 19 with rhinitis medicamentosa, and 12 with other diseases. An improvement of nasal cytology at T1 was observed in 29.2% of cases. They mainly consisted of patients with nonallergic rhinitis with neutrophils, whose neutrophil infiltrate decreased. Only 2 cases (1.7%) showed a worsening of nasal cytology at T1. A statistically significant decrease in subjective nasal obstruction was observed for every group (p < 0.05). Higher differences of nasal obstruction between T0 and T1 were found in patients with rhinitis medicamentosa or other diseases. Conclusion: RFTVR represents a safe and effective treatment for turbinate hypertrophy of various etiology. It is not responsible for a worsening of inflammatory infiltrate of the nasal mucosa.

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Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06696-7 ◽

2021 ◽

Author(s):

Lars Aksel Pedersen ◽

S. Dölvik ◽

K. Holmberg ◽

C. Ahlström Emanuelsson ◽

H. Johansson ◽

...

Keyword(s):

Beneficial Effect ◽

Nasal Obstruction ◽

General Health ◽

Surgical Skills ◽

Nasal Endoscopy ◽

Experienced Surgeon ◽

Senior Surgeon ◽

Significant Difference ◽

Before And After ◽

The Mean

Abstract Background Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. Methods Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. Results The mean nose VAS for nasal obstruction (0–100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septoplasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. Conclusions In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty.

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Respiratory mode, nasal patency and palatine dimensions

CoDAS ◽

10.1590/2317-1782/20152014177 ◽

2015 ◽

Vol 27 (2) ◽

pp. 201-206 ◽

Cited By ~ 7

Author(s):

Maria Elaine Trevisan ◽

José Humberto Bellinaso ◽

Andrielle de Bitencourt Pacheco ◽

Luciana Barros Augé ◽

Ana Maria Toniolo da Silva ◽

...

Keyword(s):

Nasal Obstruction ◽

Negative Correlation ◽

Hard Palate ◽

Nasal Patency ◽

Nasal Breathing ◽

Nose Scale ◽

Symptom Evaluation ◽

Plaster Models ◽

Digital Caliper ◽

Peak Nasal Inspiratory Flow

Purpose: To investigate the influence of breathing mode and nasal patency in the dimensions of the hard palate by comparing mouth breathing (MB) and nasal breathing (NB) adults. Methods: Seventy-seven individuals, distributed into the MB group (n=38) and the NB group (n=39), of both genders and aged between 18 and 30 years old, took part in the study. The respiratory mode diagnosis was based on anamnesis, physical characteristics, and otorhinolaryngological examination. The volunteers were evaluated in terms of nasal patency, with a peak nasal inspiratory flow (PNIF) meter, and obstruction symptoms, by a Nasal Obstruction Symptom Evaluation (NOSE) scale, and had their transversal and vertical hard palate dimensions measured with a digital caliper in plaster models. Results: Comparing both groups, the MB group presented significantly higher values in the NOSE scale, lower values in the PNIF, lower values in the transversal distance of the palate in the intercanine region, and significantly higher values in the vertical distance in the regions of the first and second premolars and molars. There was a negative correlation between PNIF and NOSE, and a positive correlation between PNIF and transversal distance of the palate in the region of the first premolars. Conclusion: MB adults presented reduced nasal patency and a higher degree of nasal obstruction symptoms. The hard palate was morphologically narrower and deeper in adults with the MB mode compared to the NB mode. Moreover, it was concluded that the smaller the nasal patency, the greater the obstruction symptoms and the narrower the hard palate.

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Evaluating the Incidence and Serverity of Rhinitis Using a Peak Nasal Inspiratory Flow Meter and the SNOT-22 Questionnaire

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.05.10472 ◽

2021 ◽

Vol 104 (5) ◽

pp. 701-708

Keyword(s):

Nasal Obstruction ◽

Diagnostic Tool ◽

Normal Population ◽

Visual Analogue Score ◽

Epidemiological Studies ◽

Inspiratory Flow ◽

Diagnostic Potential ◽

Questionnaire Surveys ◽

Peak Nasal Inspiratory Flow ◽

Snot 22

ackground: Rhinitis is a common worldwide problem that is still under-diagnosed and under-treated in many countries. Most epidemiological studies use only questionnaire surveys to gauge the severity of symptoms and lack objective diagnostic criteria to quantify the severity of symptoms such as nasal obstruction. The incidence of rhinitis was examined with the use of the Peak Nasal Inspiratory Flow (PNIF), the Sino-Nasal Outcome Test 22 (SNOT-22), and the visual analogue score (VAS) with the intention to determine the efficacy of PNIF as an objective diagnostic tool for rhinitis and to establish normal reference values for PNIF and SNOT-22 in a normal population. Materials and Methods: PNIF, SNOT-22, and VAS of 256 subjects with and without rhinitis from the general population were evaluated. Results: The incidence of rhinitis was 51% with PNIF, SNOT-22, and VAS scores being significantly better (p<0.01) in subjects without rhinitis compared to subjects with rhinitis. Median PNIF for the population with rhinitis and without was 90 L/minute and 110 L/minute, respectively. Median SNOT-22 for the population with rhinitis and without was 41 over 110 and 4 over 110, respectively. Fifty-three percent of subjects with rhinitis were unaware of the severity of their symptoms until they completed the assessments. At a PNIF cut-off point of 95 L or less per minute, there was a moderate to good diagnostic potential for rhinitis. At a SNOT-22 cut-off point of 21 or less over 110, there was an excellent diagnostic potential for rhinitis. When PNIF and SNOT-22 are used together, the diagnostic accuracy for rhinitis is 97.6%. Conclusion: The incidence of rhinitis is high and it is an unrecognized problem. PNIF is a cheap, simple, and useful objective diagnostic tool to assess changes in nasal patency and to discriminate between patients with moderate to severe rhinitis. Keywords: Rhinitis, Peak Nasal Inspiratory Flow, SNOT-22, Nasal obstruction, Epidemiology

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Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

Acta Cytologica ◽

10.1159/000518582 ◽

2021 ◽

pp. 1-7

Author(s):

Vasudha Singh ◽

Mudita Bhargava ◽

Kachnar Varma ◽

Vatsala Misra ◽

Richa Singh

Keyword(s):

Tertiary Hospital ◽

Accurate Diagnosis ◽

Exfoliative Cytology ◽

Visual Examination ◽

Normal Cytology ◽

Subjective Analysis ◽

Oral Epithelial Dysplasia ◽

Significant Difference ◽

Potentially Malignant ◽

Malignant Lesions

Introduction: Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. Material and Methods: This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. Results: On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (p value <0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. Conclusion: In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

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