Assessing nasal obstruction with the nasal acoustic device: a pilot study on distinguishing between subjects with and without chronic rhinosinusitis

This article aims to demonstrate the concept and potential of a novel diagnostic device – the nasal acoustic device (NAD), which captures the nasal breathing sounds over the ala on both sides of the nose. Using the newly defined inspiratory nasal acoustic score (INA score), the unique characteristics of the nasal breathing sounds can be quantified and used for diagnostic purposes.In this pilot study, the NAD was compared with the well-established nasal inspiratory peak flow meter (NIPF) to try to distinguish between subjects with and without chronic rhinosinusitis (CRS). Measurements were made before and after nasal decongestants, which were applied to eliminate the nasal cycle. Patients were divided into two groups based on the presence or absence of CRS, irrespective of other pathological conditions being present.Based on the post-decongestant measurements, the sensitivity/specificity in distinguishing subjects who have CRS (n=11) from subjects who do not (n=29; of whom 13 were controls) were 70%/66% for the NIPF and 82%/79% for the NAD. The non-CRS groups showed statistically significant changes after decongestant for both methods, but the CRS group did not. The results firstly demonstrated that the CRS subjects in this cohort tended to be less responsive to decongestant and therefore the post-decongestant NIPF measurements provided a certain degree of diagnostic value in identifying CRS subjects, but it would appear the NAD better captured the unique sounds associated with CRS, providing a superior diagnostic capability. This study also demonstrates that the NAD can measure the improvement in the nasal airway following treatment effect.

Patient experience of nasal obstruction and its clinical assessment

Background:The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.Method:Prospective survey of rhinology patients.Results:Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.Conclusion:Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.

Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Introduction:Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy.Patients and methods:Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 µl) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical).Results:Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 ± 18.9 and 140.0 ± 16.7 l/min before and after aspirin, respectively; p = 0.014), but not in peak expiratory flow rate (438.7 ± 33.4 and 440.0 ± 28.4 l/min before and after aspirin, respectively; p = 0.700). Nasal nitric oxide levels rose significantly (in both sides, p = 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p = 0.027; left side, p = 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p = 0.031; left side, p = 0.016).Conclusion:This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.

Degloving of the inferior turbinates: pilot study to assess the effectiveness of a new technique in turbinate reduction

A pilot study to assess the safety and efficacy of ’degloving’ of the inferior turbinate is described. This prospective study reports on the effectiveness of the technique in 37 patients with nasal obstruction due to inferior turbinate hypertrophy. Both objective and subjective measurements of nasal patency were made pre-operatively, and repeated at six weeks, six months and two years post-operatively using nasal inspiratory peak flow rates, saccharin clearance time and an end referenced visual analogue scale to record nasal symptoms.There was a significant improvement in the peak inspiratory flow at six weeks (96.4 to 151.2 l/min) and at six months (148.4 l/min), which was sustained at two years (117.1 l/min, p<0.001). There was an overall improvement in patient satisfaction with nasal symptoms (23.4 to 76.7, 76.8 and 66.8 at six weeks, six months and two years, p<0.001) and a decrease in the sensation of nasal obstruction (71.9 to 21.5, 32.9 and 29.8, p<0.001), which was also sustained. Rhinorrhoea was reduced, and sense of smell increased across the group, but the improvements did not reach statistical significance. The results for postnasal drip and saccharin clearance did not show a significant change over the period of the study. There were no haemorrhagic complications in the group studied.This pilot study demonstrates a new surgical technique for reduction of the inferior turbinates, that yields significant improvement in nasal obstruction, an acceptably low complication rate and is well tolerated by patients. A randomized controlled trial is being planned.