EEG signatures change during unilateral Yogi nasal breathing

Airflow through the left-and-right nostrils is said to be entrained by an endogenous nasal cycle paced by both poles of the hypothalamus. Yogic practices suggest, and scientific evidence demonstrates, that right-nostril breathing is involved with relatively higher sympathetic activity (arousal states), while left-nostril breathing is associated with a relatively more parasympathetic activity (stress alleviating state). The objective of this study was to further explore this laterality by controlling nasal airflow and observing patterns of cortical activity through encephalographic (EEG) recordings. Thirty subjects participated in this crossover study. The experimental session consisted of a resting phase (baseline), then a period of unilateral nostril breathing (UNB) using the dominant nasal airway, followed by UNB using the non-dominant nasal airway. A 64-channel EEG was recorded throughout the whole session. The effects of nostril-dominance, and nostril-lateralization were assessed using the power spectral density of the neural activity. The differences in power-spectra and source localization were calculated between EEG recorded during UNB and baseline for delta, theta, alpha, beta and gamma bands. Cluster-based permutation tests showed that compared to baseline, EEG spectral power was significantly (1) decreased in all frequency bands for non-dominant nostril UNB, (2) decreased in alpha, beta and gamma bands for dominant nostril UNB, (3) decreased in all bands for left nostril UNB, and (4) decreased in all bands except delta for right nostril UNB. The beta band showed the most widely distributed changes across the scalp. our source localisation results show that breathing with the dominant nostril breathing increases EEG power in the left inferior frontal (alpha band) and left parietal lobule (beta band), whereas non-dominant nostril breathing is related to more diffuse and bilateral effects in posterior areas of the brain.These preliminary findings may stimulate further research in the area, with potential applications to tailored treatment of brain disorders associated with disruption of sympathetic and parasympathetic activity.

Study on Septal Correction: Review of Literature and Clinical Findings

Septal reconstruction has many needs and usages. Nowadays, people are very concerned about looking and would like to correct them. Septal reconstruction has been immensely used in the field of cosmetics. A successful septoplasty would lead us to know about the pathology of the septum by which we can avoid further complications. It would be further significant in nasal obstruction or difficulty in breathing. Deviation of the nasal septum can also be corrected by septal reconstruction by various techniques used for septoplasty. Complete septal reconstruction is the best method for extreme S-shaped and wave-like deviations or multiple fractures. The septoplasty is performed endonasal for caudal septal deviation. Traction sutures to rectify the caudal septum deviation is another type of surgery. Septoplasty usually opens the way for all other rhinoplasty procedures, as a straight, stable septum reflects the attractiveness and functionality of the nose. The patient's history and the surgeon's expertise play a favorable outcome. In conjunction with other nose procedures, such as cosmetic rhinoplasty and endoscopic sinus surgery, Septoplasty is frequently done to alleviate nasal airway obstruction or headaches induced by rhinology irritation produced by touch. Endoscopic septoplasty requires the same amount of time and delivers equal, if not better, results than previous procedures. Visualization is vastly improved by endoscopic technology. Isolated deviation, spurs, perforations, and contact sites are examples of distinct septal disorders that can be treated individually using this procedure. In this review article, the importance of traction sutures is mentioned. The article gives us an idea about Septoplasty and how it can be achieved, its complications, risk factors, and a few postoperative points.

In Vitro Evaluation of a Nasal Interface Used to Improve Delivery from a Portable Oxygen Concentrator

Portable oxygen concentrators (POCs) are widely used to administer long-term oxygen therapy (LTOT) and employ pulsed delivery modes to conserve oxygen. Efficient pulsed delivery requires that POCs are triggered by patient inhalation. Triggering is known to fail for some patients during periods of quite breathing, as occurs during sleep. The present article describes a new nasal interface designed to improve triggering of pulsed oxygen delivery from portable oxygen concentrators (POCs). In vitro experiments incorporating realistic nasal airway replicas and simulated breathing were conducted. The pressure monitored via oxygen supply tubing (the signal pressure) was measured over a range of constant inhalation flow rates with the nasal interface inserted into the nares of the nasal airway replicas, and compared with signal pressures measured for standard and flared nasal cannulas. Triggering efficiency and the fraction of inhaled oxygen (FiO2) were then evaluated for the nasal interface and cannulas used with a commercial POC during simulated tidal breathing through the replicas. Higher signal pressures were achieved for the nasal interface than for nasal cannulas at all flow rates studied. The nasal interface triggered pulsed delivery from the POC in cases where nasal cannulas failed to trigger. FiO2 was significantly higher for successful triggering cases than for failed triggering cases. The nasal interface improved triggering of pulsed oxygen delivery from a POC and presents a simple solution that could be used with commercially-available POCs to reliably supply oxygen during periods of quiet breathing.

Comparison of airway pressures and expired gas washout for nasal high flow versus CPAP in child airway replicas

Background For children and adults, the standard treatment for obstructive sleep apnea is the delivery of continuous positive airway pressure (CPAP). Though effective, CPAP masks can be uncomfortable to patients, contributing to adherence concerns. Recently, nasal high flow (NHF) therapy has been investigated as an alternative, especially in CPAP-intolerant children. The present study aimed to compare and contrast the positive airway pressures and expired gas washout generated by NHF versus CPAP in child nasal airway replicas. Methods NHF therapy was investigated at a flow rate of 20 L/min and compared to CPAP at 5 cmH2O and 10 cmH2O for 10 nasal airway replicas, built from computed tomography scans of children aged 4–8 years. NHF was delivered with three different high flow nasal cannula models provided by the same manufacturer, and CPAP was delivered with a sealed nasal mask. Tidal breathing through each replica was imposed using a lung simulator, and airway pressure at the trachea was recorded over time. For expired gas washout measurements, carbon dioxide was injected at the lung simulator, and end-tidal carbon dioxide (EtCO2) was measured at the trachea. Changes in EtCO2 compared to baseline values (no intervention) were assessed. Results NHF therapy generated an average positive end-expiratory pressure (PEEP) of 5.17 ± 2.09 cmH2O (mean ± SD, n = 10), similar to PEEP of 4.95 ± 0.03 cmH2O generated by nominally 5 cmH2O CPAP. Variation in tracheal pressure was higher between airway replicas for NHF compared to CPAP. EtCO2 decreased from baseline during administration of NHF, whereas it increased during CPAP. No statistical difference in tracheal pressure nor EtCO2 was found between the three high flow nasal cannulas. Conclusion In child airway replicas, NHF at 20 L/min generated average PEEP similar to CPAP at 5 cm H2O. Variation in tracheal pressure was higher between airway replicas for NHF than for CPAP. The delivery of NHF yielded expired gas washout, whereas CPAP impeded expired gas washout due to the increased dead space of the sealed mask.

Mouth breathing – A predictor for patient satisfaction after nasal septoplasty?

Background: No reliable marker exists to predict septoplasty outcome. Most patients suffering from nasal airway obstruction (NAO) caused by a deviation of the nasal septum report a bothersome mouth breathing and dryness. In this study our aim was to assess, whether mouth breathing could be objectified in these patients and whether mouth breathing could predict septoplasty outcome. Methods: A monocentric, prospective case-control study of 21 patients was conducted. The proportion of mouth breathing was measured in a blinded manner. As a measurement of patient satisfaction, subjective symptoms pre- and postoperatively, were assessed by using VAS, NOSE and SNOT-20 score. In the patient group an additional acoustic rhinometry and a clinical examination of the nose were performed. Results: With a mean of 25% (SD = 20%) the proportion of mouth breathing in patients with NAO did not differ significantly from the proportion in controls without NAO, with a mean of 27% (SD = 23%). Analysis of subjective scores revealed a significant reduction of subjective symptoms after septoplasty. A higher preoperative proportion of mouth breathing correlated with more remaining postoperative NAO. Conclusions: The percentage of mouth breathing is no different in patients with symptomatic septal deviation than in control patients. Mouth breathing in patients with NAO, evaluated for septoplasty, could be a negative predictive factor for patient satisfaction after nasal septoplasty. Mouth breathing in these patients should be observed carefully because more preoperative mouth breathing should make one more hesitant to consider septoplasty.

Key Considerations in Practices and Principles of Endoscopic Septoplasty: Lessons, Mistakes and Future

Background: Conventional surgeries of the nasal septum improve the nasal airway but recent development and advancement of the knowledge about the endoscopic septoplasty has significantly changed the treatment modality and had brought focus over several aspects of possible advantages. This study aims to see the advantages, complications and limitations of endoscopic septoplasty. Methods: It was an observational prospective study conducted over 90 patients of symptomatic deviated nasal septum. It evaluated symptoms, anterior rhinoscopy and nasal endoscopy findings, objective and subjective improvement of symptoms using the nasal obstruction symptom evaluaiton (NOSE) score, post-operative pain using the visual analogue scale (VAS) and complication following the surgery. Results: Deviated nasal septum (DNS) either left or right side was the most common examination finding 97.78%. Post-operatively there was a good symptom relief and significant subjective improvement in NOSE scores with average decline in the score by 96.26%. Objective assessment of all patients showed improved airway. The complication rate was minimum 7.78%. Conclusion: Endoscopic septoplasty (ES) was found to have distinct advantages with good subjective and objective improvement of symptoms and lesser rate of complications. It should be an option offered to all patients requiring septoplasty. We also found that it helps in improving the learning curve and surgical skill of the trainees. Bangladesh J Otorhinolaryngol 2021; 27(2): 170-176

Effects of Tham Nasal Alkalinization on Airway Microbial Communities: A Pilot Study in Non-CF and CF Adults

Objectives: In cystic fibrosis (CF), loss of CFTR-mediated bicarbonate secretion reduces the airway surface liquid (ASL) pH causing airway host defense defects. Aerosolized sodium bicarbonate can reverse these defects, but its effects are short-lived. Aerosolized tromethamine (THAM) also raises the ASL pH but its effects are much longer lasting. In this pilot study, we tested the hypothesis that nasally administered THAM would alter the nasal bacterial composition in adults with and without CF. Methods: Subjects (n = 32 total) received intranasally administered normal saline or THAM followed by a wash out period prior to receiving the other treatment. Nasal bacterial cultures were obtained prior to and after each treatment period. Results: At baseline, nasal swab bacterial counts were similar between non-CF and CF subjects, but CF subjects had reduced microbial diversity. Both nasal saline and THAM were well-tolerated. In non-CF subjects, nasal airway alkalinization decreased both the total bacterial density and the gram-positive bacterial species recovered. In both non-CF and CF subjects, THAM decreased the amount of Corynebacterium accolens detected, but increased the amount of Corynebacterium pseudodiphtheriticum recovered on nasal swabs. A reduction in Staphylococcus aureus nasal colonization was also found in subjects who grew C. pseudodiphtheriticum. Conclusions: This study shows that aerosolized THAM is safe and well-tolerated and that nasal airway alkalinization alters the composition of mucosal bacterial communities. Clinical Trial Registration: NCT00928135 ( https://clinicaltrials.gov/ct2/show/NCT00928135 ).

Metabolic Reprogramming of Nasal Airway Epithelial Cells Following Infant Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) is a seasonal mucosal pathogen that infects the ciliated respiratory epithelium and results in the most severe morbidity in the first six months of life. RSV is a common cause of acute respiratory infection during infancy and is an important early-life risk factor strongly associated with asthma development. While this association has been repeatedly demonstrated, limited progress has been made on the mechanistic understanding in humans of the contribution of infant RSV infection to airway epithelial dysfunction. An active infection of epithelial cells with RSV in vitro results in heightened central metabolism and overall hypermetabolic state; however, little is known about whether natural infection with RSV in vivo results in lasting metabolic reprogramming of the airway epithelium in infancy. To address this gap, we performed functional metabolomics, 13C glucose metabolic flux analysis, and RNA-seq gene expression analysis of nasal airway epithelial cells (NAECs) sampled from infants between 2–3 years of age, with RSV infection or not during the first year of life. We found that RSV infection in infancy was associated with lasting epithelial metabolic reprogramming, which was characterized by (1) significant increase in glucose uptake and differential utilization of glucose by epithelium; (2) altered preferences for metabolism of several carbon and energy sources; and (3) significant sexual dimorphism in metabolic parameters, with RSV-induced metabolic changes most pronounced in male epithelium. In summary, our study supports the proposed phenomenon of metabolic reprogramming of epithelial cells associated with RSV infection in infancy and opens exciting new venues for pursuing mechanisms of RSV-induced epithelial barrier dysfunction in early life.

Identification of Risk Factors Associated With Mortality Among Patients With COVID-19 Using Random Forest Model: A Historical Cohort Study

There is conflicting evidence about factors associated with Clinical course and risk factors for mortality of adult inpatients. We aimed to identify the demographic, clinical, treatment, and laboratory data factors associated with mortality in the Khoy district. We performed a retrospective cohort study including COVID-19 infected patients who were admitted to Qamar-Bani Hashim hospital from 2 November 2020 to 4 December 2020. We used random forest methods to explore the risk factors associated with death. The applied method was evaluated using sensitivity, specificity, accuracy, and the area under the curve. Age, pulmonary symptoms, patients need a ventilator, brain symptoms, nasal airway, job were the most important risk factors for mortality of COVID-19 in the random forest (RF) method. The RF method showed the highest accuracy, 82.9 and 79.3, for training and testing samples, respectively. However, this method resulted in the highest specificity (89.5% for training and 95.7% for testing sample) and the highest sensitivity (91.9% for training and 94.5% for testing sample). The potential risk factors consisting of older age, pulmonary symptoms, the use of a ventilator, brain symptoms, nasal airway, and the job could help clinicians to identify patients with poor prognosis at an early stage.