MEDICAL VS SURGICAL TREATMENT FOR SYMPTOMATIC ENLARGED INFERIOR TURBINATE: A COMPARATIVE STUDY

Objective: To determine the nasal patency after reducing the size of hypertrophied inferior turbinate with medication and surgery. Study Design: Prospective comparative study. Place and Duration of Study: Department of Ear, Nose, Throat, Head and Neck Surgery, Medical Teaching Institute, Lady Reading Hospital, Peshawar Pakistan, from Jan to Dec 2019. Methodology: This study was conducted at the After-sample size calculation using an online sample size calculator (OpenEpi) and after obtaining informed consent patients were divided into two groups. Patients in group A were put on medicine only and in group B surgery was conducted to reduce the size of hypertrophied inferior turbinate. Data were analyzed using SPSS version 25 and p<0.05 was considered significant. Results: This study comprised of total 86 patients, in the age range 15-55 years with mean ± SD age 33.47 ± 9.57 years. Males were 47 (54.7%) and females were 39 (45.3%) with male to female ratio of 1.2:1. In group A, males were 22 (25.25%), females were 21 (24.41%), while in group B males were 25 (29.1%) and females were 18 (20.3%). There was no statistically significant difference in nasal patency between the two groups before treatment (p=0.59) and after 10 days of treatment (p=0.69). However, at the end of one month, there was a statistically significant difference in nasal patency between the medically treated and surgically treated groups of patients (p=0.023).Conclusion: Surgical treatment is significantly effective than medical treatment alone.

Effects of Acute Alcohol Intake on Nasal Patency

Background Acute alcohol intake may influence nasal patency; however, there is lack of objective evidence. Objective The aim of this study was to evaluate the effects of acute alcohol intake on nasal patency employing both subjective and objective measures. Methods A total of 31 participants were classified into 2 groups of non-heavy drinkers (n = 17) and heavy drinkers (n = 14). Both groups consumed wine in 1 h and were assessed for subjective nasal symptoms and objective nasal patency, using rhinomanometry and acoustic rhinometry, at baseline and at 0.5, 2, and 6 h post-alcohol consumption. Results Alcohol consumption significantly increased nasal obstruction from baseline values in both heavy and non-heavy drinking groups. Total nasal volume (TNV) and the minimal cross-sectional area (MCA) were significantly decreased and nasal airway resistance (NAR) significantly increased from baseline values by 2 h post-alcohol consumption for both heavy and non-heavy drinking groups ( P < .05). Significant differences were found in TNV, MCA, and NAR between baseline and post-drinking in allergic rhinitis subjects; with no significant differences in MCA and NAR in subjects without allergic rhinitis. Pulse rate (PR) and temperature (T) were elevated, and blood pressure (BP) was decreased after alcohol consumption ( P < .05). Blood alcohol concentration (BAC) was not significantly correlated with nasal patency with regard to any subjective or objective measurement. Conclusion Acute alcohol consumption may impair nasal patency, independent of the amount consumed. Individuals with allergic rhinitis may be more prone to nasal obstruction after alcohol consumption than those without allergic rhinitis.

Comparison of nasal patency after nose-blowing between pinch versus no pinch method: a randomized controlled trial

We proposed that nose-blowing without pinching was safer and able to get rid of mucus and maintain nasal patency as effective as the pinch and blow method. The objective of this study was to evaluate the nasal patency after nose-blowing by pinching the nose versus no pinching. The patients who have nasal discharge such as allergic rhinitis or common cold were recruited. The patients were randomized to perform pinching or no pinching nose-blowing. Fifty patients were enrolled in this study. The objective evaluation using acoustic rhinometry found no difference in nasal patency between the two groups (p > 0.05). The subjective patency score was significantly higher in the pinch one nostril shut group (mean difference 0.88, 95% CI 0.20–1.55). The patency of the two methods were comparable according to the objective test. However, the patients felt that their nose was clearer when pinching and blowing.

Comparison of the Efficacy of Septoplasty with NonSurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum - A Randomized Clinical Trial

Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven. Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management. Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups. Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p = 0.001). Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.

Sense of smell disorders in family physician practice

A properly functioning sense of smell recognizes both food and danger and provides sensory input. Sense of smell is lost and/or impaired in diseases accompanied by impaired nasal patency such as chronic rhinosinusitis with or without nasal polyps, allergic rhinitis, respiratory infections including acute rhinosinusitis. In the case of rhinosinusitis in adults, olfactory impairment is one of the four main symptoms of the disease. They can also be caused by damage to the olfactory neuron, e.g. in the course of a viral infection. Loss of smell and/or taste reported by patients with COVID-19 may be a diagnostic hint. Modern intranasal glucocorticosteroids are used to treat olfactory disturbances and loss of smell caused by nasal patency impairment (or accompanying diseases with nasal patency impairment).

Effects of Supine and Prone Positions on Nasal Patency in Healthy Individuals

Objectives: Supine position reduces nasal patency compared with that in the sitting position; however, data on the effects of prone position on nasal patency is lacking. Methods: We assessed the nasal patency of 30 healthy individuals without upper respiratory tract disorders by using visual analog scale (VAS) score and acoustic rhinometry in 7 positions: sitting; frontal, right, and left supine; and frontal, right, and left prone. Results: According to the VAS scores, compared with that in the sitting position, both the supine and prone positions significantly increased subjective nasal obstruction ( P < .001). The prone position had a more significant effect than did the supine position ( P = .017). The results of minimal cross-sectional area measured through acoustic rhinometry demonstrated that both the supine and prone positions reduced the nasal patency significantly, but without significant differences between the effects of prone and supine positions ( P = .794). Conclusion: This is the first study to elucidate that the prone position can significantly reduce the nasal patency in healthy individuals through subjective and objective assessments. Level of Evidence: IV

Investigation of Repeatability of Peak Nasal Inspiratory Flow Rate Measurements Under Baseline Conditions and After Administration of 0.05% Oxymetazoline

Objectives Peak nasal inspiratory flow (PNIF) measurement is an inexpensive and user-friendly method to assess nasal patency. However, the repeatability of PNIF measurements, as well as the threshold value of a change in PNIF, which can be considered significant remain unclear. This study aims to investigate the repeatability of PNIF measurements and the change in PNIF after the administration of 0.05% oxymetazoline. Methods Repeated measurements of PNIF (Clement Clarke In-Check nasal inspiratory flow meter; Clement Clarke International, Ltd, Harlow, Essex, UK) were obtained in 333 healthy volunteers (174 women). Based on age, participants were categorized into three groups (6–7 years, 13–14 years, and 20–45 years). We obtained five measurements in each participant. PNIF was remeasured in 294 subjects 30 min after administration of 0.05% oxymetazoline. The variability in PNIF measurements was assessed using the coefficient of variation (CV = standard deviation × 100%/mean). Results The first four PNIF measurements significantly differed from each other. The difference in PNIF measurements ceased to be statistically significant only between the fourth and fifth measurements (p = 0.19). PNIF repeatability was acceptable; the median CV was 15.5% (0–66), which did not significantly differ between age groups. The administration of 0.05% oxymetazoline led to a statistically significant increase in the PNIF value by 14.3% (−45, 157%) (p = 0.000000). Conclusions 1. No statistically significant difference was observed in PNIF values only between the fourth and fifth measurements; therefore, at least three measurements are essential to draw meaningful conclusions. 2. PNIF measurements were satisfactorily characterized by a relatively low CV (15%). 3. The administration of 0.05% oxymetazoline led to an increase in PNIF by approximately 14% over the baseline value.

Effects of Renewable Diesel Exhaust on Lung Function and Self-rated Symptoms for Healthy Volunteers in a Human Chamber Exposure Study

Background: Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust on human health is less known. In this study, nasal patency, pulmonary function, and self-rated symptoms were assessed in 19 healthy volunteers after two separate 3-hour exposures to renewable diesel (hydrotreated vegetable oil [HVO]) exhaust, and exposure to filtered air (FA) for comparison. The HVO exposures were generated with two modern non-road vehicles (2019) having either: 1) no aftertreatment system (HVOPM+NOx), or 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter (HVONOx). The exposure concentrations complied with current EU occupational exposure limits (OELs) of NO, NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and future OELs of elemental carbon (EC) from 2023. Results: Exposure to HVOPM+NOx consisted of PM1 (≈90 µg m-3, 54 µg m-3 EC) and NOx (NO 3.4 ppm, NO2 0.6 ppm). The average total respiratory tract deposition of PM1 was 27 µg h-1. The deposition fraction of HVO PM1 was 40-50% higher compared to diesel exhaust PM1 from an older vehicle, due to smaller particle sizes of the HVOPM+NOx exhaust. Exposure to HVONOx consisted mainly of NOx (NO 2.0 ppm, NO2 0.7 ppm) with low level of PM1 (~1 µg m-3). Compared to filtered air, exposure to HVOPM+NOx and HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p<0.03). Especially, exposure to HVOPM+NOx showed 40-50% higher eye and throat irritation symptoms. Compared to filtered air, a decrement in nasal patency was found for the HVONOx exposures (-18.1, 95%CI: -27.3 to -8.8 L min-1), and for the HVOPM+NOx (-7.4 (-15.6 to 0.8) L min-1). Overall, no change was indicated in the pulmonary function tests (spirometry, peak expiratory flow, forced oscillation technique), except a slight increase in FEV1/FVC after exposure to HVONOx.Conclusion: Short-term exposure to HVO exhaust below the EU OELs did not cause severe pulmonary function changes in healthy subjects. However, an increase in self-rated mild irritation symptoms, and mild decrease in nasal patency after two HVO exposures may indicate irritative effects from exposure to HVO exhaust from modern non-road vehicles below future OELs.

Cephalic lateral crural advancement flap

Background In lower lateral cartilage (LLC) surgery, cephalic trimming poses risks for the collapse of the internal and external nasal valves, pinched nose, and drooping deformity. The cephalic lateral crural advancement (CLCA) technique presented herein was aimed at using a flap to increase nasal tip rotation and support the lateral crus, in addition to the internal and external nasal valves, by avoiding grafts without performing excision.<br/>Methods This study included 32 patients (18 female and 14 male) and the follow-up period for patients having undergone primer open rhinoplasty was 12 months. The LLC was elevated from the vestibular skin using the CLCA flap. A cephalic incision was performed without cephalic trimming. Two independent flaps were formed while preserving the scroll ligament complex. The CLCA flap was advanced onto the lower lateral crus while leaving the scroll area intact. The obtained data were analyzed retrospectively.<br/>Results The mean age of the patients was 31.6 years (range, 20–51 years). The Rhinoplasty Outcome Examination scores after 12 months varied from 90 to100 points, and 93% of patients reported perfect satisfaction. At a 1-year follow-up, the patients’ nasal patency (visual analogue scale) rose from 4.56±1.53 (out of 10) to 9.0±0.65 (P<0.001).<br/>Conclusions The CLCA flap led to better nasal tip definition by protecting the scroll area, increasing tip rotation, and supporting the internal and external nasal valves without cephalic excision.