Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

AbstractBackground:Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery.Aim:To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test.Methods:Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated.Results:Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps.Conclusion:The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.

Download Full-text

Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

Rhinology Journal ◽

10.4193/rhino13.126 ◽

2014 ◽

Vol 52 (2) ◽

pp. 116-121

Author(s):

D. Chin ◽

G. Marcells ◽

J. Malek ◽

E. Pratt ◽

R. Sacks ◽

...

Keyword(s):

Nasal Obstruction ◽

Surgical Intervention ◽

Cross Sectional Study ◽

Inspiratory Flow ◽

Cross Sectional ◽

Predictive Values ◽

Peak Inspiratory Flow ◽

Airways Resistance ◽

Nasal Peak Inspiratory Flow ◽

Turbinate Reduction

Background: Identifying the cause of nasal obstruction is critical before surgical intervention. Structural nasal obstruction, due to nasal valve stenosis, is unlikely to benefit from simple septoplasty and turbinate reduction. This study assesses changes in nasal peak inspiratory flow (NPIF) as a tool for discriminating decongestable versus structural obstruction. Methodology: Cross-sectional study of patients undergoing nasal airflow assessment was performed. Rhinomanometry, nasal obstruction visual analogue scores (VAS) and NPIF were performed pre- and post-decongestion. Population groups were defined with decongestable or structural obstruction by relative post-decongestion changes in airways resistance and symptoms. Results: Fifty two patients were assessed, 24 with decongestable, 28 with structural obstruction. Pre- and post-decongestion NPIF were similar between groups. Absolute and percentage NPIF change were larger with decongestable versus structural obstruction. Sensitivity and specificity for predicting decongestable obstruction were 75.0% and 60.7% for NPIF increase >20 L/min; 75.0% and 64.3% for NPIF increase >20%. The respective positive predictive values were 62.1% and 64.3%. Conclusion: NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

Download Full-text

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

Download Full-text