<p>Funkcija nosa povezana je sa različitim anatomskim, fiziolo&scaron;kim i emocionalnim faktorima. Postoji mnogo teorija koje su poku&scaron;ale da objasne efekat ženskih polnih hormona (estrogena i progesterona) na fiziologiju nosa, ali sam mehanizam njihovog dejstva jo&scaron; uvek ostaje izazov za mnoge istraživače. Prethodno je opisano da ženski polni hormoni mogu da izazovu nazalnu opstrukciju, povećavajući ekspresiju histaminskih H1 receptora i menjajući koncentraciju neurotransmitera, &scaron;to dovodi do edema nosne sluznice i modifikacije nazalnog otpora. Kada je reč o mirisnoj funkciji na malom broju ispitanika i u različito dizajniranim studijama je pokazano da je u fazi ovulacije mirisni prag značajno niži u odnosu na folikularnu i luteinsku fazu, međutim ne postoje podaci o identifikaciji i diskriminaciji mirisa u menstrualnom ciklusu. Nizak nivo estrogena prouzrokovan fiziolo&scaron;kom atrofijom jajnika u postmenopauzi može dovesti do hiposmije ili čak anosmije, &scaron;to predstavlja jo&scaron; jedan dokaz o osetljivosti nazalne sluznice na estrogen.&nbsp; Cilj ovog istraživanja je bio da se ispita uticaj ženskih polnih hormona na respiratornu i mirisnu funkciju nosa u menstrualnom ciklusu i postmenopauzi. Istraživanje je u celosti prospektivno, sprovedeno je na Zavodu za fiziologiju, Medicinskog fakulteta, Univerziteta u Novom Sadu. Uključeno je 204 osoba ženskog pola koje su bile podeljene u dve grupe. Prvu grupu su činile 103 devojke uzrasta 23,126 &plusmn; 4,597 godina u reproduktivnom periodu sa regularnim menstrualnim ciklusom i 101 žena prosečnog uzrasta 60,069 &plusmn; 5,570 u postmenopauzi. Respiratorna i mirisna funkcija nosa procenjene su uz pomoć odgovarajućih standaradizovanih objektivnih i subjektivnih metoda. Funkcija donjih disajnih puteva ispitana je uz pomoć spirometrije. Kod žena u reproduktivnom periodu testiranje se vr&scaron;ilo u fazi ovulacije i lutealnoj fazi menstrualnog ciklusa, a kod ispitanica u postmenopauzi jednom. Nakon određivanja prvog plodnog dana ispitanice su uz pomoć standardizovanih urin - tračica za određivanje pika luteinizirajućeg hormona u urinu utvrđivale momenat ovulacije, dok se drugo testiranje u lutealnoj fazi vr&scaron;ilo sedam dana nakon prvog. Respiratorna funkcija nosa je značajno lo&scaron;ija u fazi ovulacije u odnosu na progesteronsku fazu menstrualnog ciklusa,ali se značajno ne razlikuje između žena u reproduktivnom periodu i žena u postmenopauzi. Subjektivni osećaj nazalne opstrukcije značajno se ne razlikuje u različitim fazama menstrualnog ciklusa, kao ni između testiranih populacija zdravih žena. Sposobnost identifikacije mirisa je statistički značajno slabija, a subjektivni osećaj intenziteta mirisa izraženiji u fazi ovulacije u odnosu na luteinsku fazu menstrualnog ciklusa. Međutim, sposobnost identifikacije mirisa značajno je lo&scaron;ija kod žena u postmenopauzi u odnosu na obe faze menstrualnog ciklusa. Reaktivnost nosne sluznice značajno je veća u fazi ovulacije u odnosu na lutealnu fazu menstrualnog ciklusa, ali se ista ne razlikuje između žena u reproduktivnom period i žena u postmenopauzi. Respiratorna i mirisna funkcije nosa u testiranim populacijama zdravih žena nisu značajno povezane.</p> / <p>The nasal function is associated with various anatomical, physiological and emotional factors. There are many theories that have tried to explain the effect of female sex hormones (estrogen and progesterone) on the nasal physiology, but the mechanism still remains unknown for many researchers. It has been previously described that female sex hormones can cause nasal obstruction by increasing the expression of histamine H1 receptors and altering the concentration of neurotransmitters, which leads to edema of the nasal mucosa and modification of nasal resistance. When it comes to olfaction on a small number of subjects and in differently designed studies, it was shown that in the ovulatory phase the olfactory threshold is significantly lower compared to the follicular and luteal phase, however there are no data on the identification and discrimination of odors in the menstrual cycle. Low estrogen levels caused by physiological atrophy of the ovaries in postmenopause can lead to hyposmia or even anosmia, which is another proof of the sensitivity of the nasal mucosa to estrogen.&nbsp; The aim of this study was to examine the effect of female sex hormones on respiratory and olfactory function of the nose in the menstrual cycle and postmenopause. The research is prospective and it was conducted at the Department of Physiology, Faculty of Medicine, University of Novi Sad. It included 204 females who were divided into two groups. The first group consisted of 103 women aged 23.126 &plusmn; 4.597 years in the reproductive period with a regular menstrual cycle and 101 women with an average age of 60.069 &plusmn; 5.570 in the postmenopausal period. The respiratory and olfactory function of the nose were assessed using appropriate standardized objective and subjective methods. The lower airway function was examined using spirometry. Young women in reproductive period were tested twice, in the ovulatory and luteal phase of the menstrual cycle, and the postmenopausal women were tested only once. After menstrual bleeding the participans used standardized urine strips consecutively day by day to determine ovulation (the peak of the luteinizing hormone (LH) in plasma which pointed out the estrogen plasma peak). The test was positive if two horizontal pink streaks appeared on the strip 5 to 10 minutes after the contact with the urine. One pink streak indicates a correctly performed test, while the second streak appears only if there is an LH peak. Within 24 hours of confirmed LH peak, the subjects were tested for the first time. The second measurement was performed in the luteal phase of the menstrual cycle (the progesterone plasma peak) seven days after the first one.&nbsp; The nasal respiratory function is significantly worse in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ significantly between women in the reproductive period and postmenopausal women. The subjective sense of the nasal obstruction does not differ significantly in different phases of the menstrual cycle, as well as between tested populations of healthy women. The odor identification ability is statistically significant weaker and the subjective sense of odor intensity is more pronounced in the ovulatory phase compared to the luteal phase of the menstrual cycle. However, the ability to identify odors is significantly worse in postmenopausal women compared to both phases of the menstrual cycle. The reactivity of the nasal mucosa is significantly higher in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ between women in the reproductive period and postmenopausal women. The respiratory and olfactory nasal functions in these tested populations are not significantly corelated.</p>

Introdução: A atresia transversa da maxila é a discrepância volumétrica existente entre a maxila e a mandíbula no plano transversal que, além de alterações dento-esqueléticas, gera mudanças craniofaciais importantes, como o estreitamento das cavidades nasais, a diminuição da permeabilidade nasal e a respiração bucal. A expansão palatina cirurgicamente assistida (EPCA) é a técnica cirúrgica indicada para a correção da atresia maxilar em pacientes adultos, com o crescimento ósseo finalizado. A rinometria acústica é uma técnica objetiva de estudo da respiração nasal, com a qual se avalia a geometria e o volume nasal. Já a rinomanometria trata-se de um método aerodinâmico que quantifica a pressão transnasal e a resistência ao fluxo aéreo. Objetivos: O objetivo deste estudo foi avaliar subjetiva e objetivamente a função respiratória nasal, em pacientes com atresia maxilar, submetidos à EPCA e determinar o tipo de correlação existente entre as medidas ortodônticas e as alterações de área, volume, resistência, e fluxo aéreo nasal. Casuística e Métodos: Para a realização do estudo foram avaliados 27 pacientes adultos, por meio da rinometria acústica, rinomanometria, medidas ortodônticas (perímetro e comprimento do arco maxilar, distância transversa entre caninos, prés-molares e molares superiores) em modelos de estudos e escala visual analógica da função respiratória apenas nasal, no pré-operatório, após a ativação do expansor maxilar do tipo Hyrax, instalado previamente à cirurgia, e após quatro meses da EPCA, realizada sob anestesia geral. Os exames otorrinolaringológicos foram realizados em sala ambientalizada, com e sem o uso de vasoconstritor nasal, em ambas as cavidades nasais. Resultados: Os resultados demonstraram que 59,3% da casuística era do gênero feminino, com idade média de 25,33 anos. Todas as medidas ortodônticas obtiveram um aumento estatisticamente significante (p<0,001), que mantiveram-se ao longo da tempo (p<0,001). Todas as medidas avaliadas apresentaram melhores resultados com o uso de vasoconstritor nasal. A área da cavidade nasal como um todo aumentou após a cirurgia (p<0,036). O volume médio é 2,75 maior com o uso de vasoconstritor (p < 0,001), porém não houve alterações estatisticamente significantes entre os momentos avaliados. Os fluxos expiratórios e inspiratórios aumentaram ao longo do tempo (p<0,001, para ambos). A pressão expiratória diminui no decorrer dos momentos avaliados (p<0,004). A análise subjetiva da sensação respiratória apenas pelo nariz aumentou significantemente de um momento para o outro (p<0,05). Houve correlação estatística entre perímetro do arco aumentado e resistência aérea diminuída (p=0,004) e entre o aumento de uma medida transversa com o aumento do fluxo inspiratório e expiratório, sem o uso de vasoconstritor (p=0,023 e p=0,004 respectivamente). Apenas o fluxo respiratório apresentou comportamento diferente entre os lados. Conclusões: Assim, conclui-se que o procedimento cirúrgico de EPCA promove alterações importantes nas cavidades oral e nasais que, associadas, geram melhor qualidade respiratória ao paciente e demonstram a relevância clínica otorrinolaringológica de tal procedimento cirúrgico bucomaxilofacial / Introduction: Transverse atresia of maxilla is a volumetric discrepancy existing between the maxilla and the mandible on the transversal plan that, besides dentoskeletal alterations, generates important craniofacial changes, such as nasal cavities constriction, diminution of nasal permeability and buccal breathing. The surgically assisted rapid maxillary expansion (SARME) is the surgical technique indicated for correcting maxillary atresia in adult patients, whose bone development was concluded. Acoustic rhinometry is a technique of nasal breathing, with which the nasal geometry and volume are assessed. As for rhinomanometry, it is an aerodynamic method that quantifies the transnasal pressure and resistance to aerial flow. Objectives: The purpose of this paper was evaluating subjectively and objectively the nasal respiratory function in patients with maxillary atresia, who have undergone SARME and determining the type of correlation existing between the orthodontic measures and the alterations of area, volume, resistance, and nasal aerial flow. Casuistic and Methods: For the paper accomplishment were assessed 27 adult patients, through acoustic rhinometry, rhinomanometry, orthodontic measures (perimeter and length of maxillary arch, transverse distance among canines, premolars and superior molars) in models of studies and analogical visual scale of only nasal respiratory function, on pre-surgical, after the activation of Hyrax-type maxillary expander, installed previously to the surgery, and after four months of SARME, accomplished under general anesthesia. The otorhinolaryngological tests were accomplished in an environmentally adapted room, with and without the use of nasal vasoconstrictor, in both nasal cavities. Results: The results have demonstrated that 59.3% of the casuistic was of female gender, with an average age of 25.33 years. All the orthodontic measures have obtained a statistically significant growth (p<0.001), which have maintained along the time (p<0.001). All the assessed measures have presented better results with the use of nasal vasoconstrictor. The nasal cavity area as a whole augmented after the surgery (p<0.036). The average volume is 2.75 larger with the vasoconstrictor use (p < 0.001), however, there was any statistically significant alterations between the moments assessed. The expiratory and inspiratory flows have grown along the time (p<0.001, for both). The expiratory pressure is reduced in the course of the moments assessed (p<0.004). The subjective analysis of respiratory sensation only through nose has increased significantly from one moment to the other (p<0.05). There was a statistic correlation between perimeter of augmented arch and aerial resistance diminished (p=0.004) and between the increase of a transverse measure with the growth of inspiratory and expiratory flow, with and without the use of vasoconstrictor (p=0.023 and p=0.004 respectively). Only the respiratory flow presented a different behavior between the sides. Conclusions: Thus, it is concluded that the SARME promotes important alterations on oral and nasal cavities that, associated, generate a better respiratory quality to the patient and demonstrate a clinical otorhinolaryngological relevance of such bucomaxillofacial surgical procedure

Introdução: A atresia transversa da maxila é a discrepância volumétrica existente entre a maxila e a mandíbula no plano transversal que, além de alterações dento-esqueléticas, gera mudanças craniofaciais importantes, como o estreitamento das cavidades nasais, a diminuição da permeabilidade nasal e a respiração bucal. A expansão palatina cirurgicamente assistida (EPCA) é a técnica cirúrgica indicada para a correção da atresia maxilar em pacientes adultos, com o crescimento ósseo finalizado. A rinometria acústica é uma técnica objetiva de estudo da respiração nasal, com a qual se avalia a geometria e o volume nasal. Já a rinomanometria trata-se de um método aerodinâmico que quantifica a pressão transnasal e a resistência ao fluxo aéreo. Objetivos: O objetivo deste estudo foi avaliar subjetiva e objetivamente a função respiratória nasal, em pacientes com atresia maxilar, submetidos à EPCA e determinar o tipo de correlação existente entre as medidas ortodônticas e as alterações de área, volume, resistência, e fluxo aéreo nasal. Casuística e Métodos: Para a realização do estudo foram avaliados 27 pacientes adultos, por meio da rinometria acústica, rinomanometria, medidas ortodônticas (perímetro e comprimento do arco maxilar, distância transversa entre caninos, prés-molares e molares superiores) em modelos de estudos e escala visual analógica da função respiratória apenas nasal, no pré-operatório, após a ativação do expansor maxilar do tipo Hyrax, instalado previamente à cirurgia, e após quatro meses da EPCA, realizada sob anestesia geral. Os exames otorrinolaringológicos foram realizados em sala ambientalizada, com e sem o uso de vasoconstritor nasal, em ambas as cavidades nasais. Resultados: Os resultados demonstraram que 59,3% da casuística era do gênero feminino, com idade média de 25,33 anos. Todas as medidas ortodônticas obtiveram um aumento estatisticamente significante (p<0,001), que mantiveram-se ao longo da tempo (p<0,001). Todas as medidas avaliadas apresentaram melhores resultados com o uso de vasoconstritor nasal. A área da cavidade nasal como um todo aumentou após a cirurgia (p<0,036). O volume médio é 2,75 maior com o uso de vasoconstritor (p < 0,001), porém não houve alterações estatisticamente significantes entre os momentos avaliados. Os fluxos expiratórios e inspiratórios aumentaram ao longo do tempo (p<0,001, para ambos). A pressão expiratória diminui no decorrer dos momentos avaliados (p<0,004). A análise subjetiva da sensação respiratória apenas pelo nariz aumentou significantemente de um momento para o outro (p<0,05). Houve correlação estatística entre perímetro do arco aumentado e resistência aérea diminuída (p=0,004) e entre o aumento de uma medida transversa com o aumento do fluxo inspiratório e expiratório, sem o uso de vasoconstritor (p=0,023 e p=0,004 respectivamente). Apenas o fluxo respiratório apresentou comportamento diferente entre os lados. Conclusões: Assim, conclui-se que o procedimento cirúrgico de EPCA promove alterações importantes nas cavidades oral e nasais que, associadas, geram melhor qualidade respiratória ao paciente e demonstram a relevância clínica otorrinolaringológica de tal procedimento cirúrgico bucomaxilofacial / Introduction: Transverse atresia of maxilla is a volumetric discrepancy existing between the maxilla and the mandible on the transversal plan that, besides dentoskeletal alterations, generates important craniofacial changes, such as nasal cavities constriction, diminution of nasal permeability and buccal breathing. The surgically assisted rapid maxillary expansion (SARME) is the surgical technique indicated for correcting maxillary atresia in adult patients, whose bone development was concluded. Acoustic rhinometry is a technique of nasal breathing, with which the nasal geometry and volume are assessed. As for rhinomanometry, it is an aerodynamic method that quantifies the transnasal pressure and resistance to aerial flow. Objectives: The purpose of this paper was evaluating subjectively and objectively the nasal respiratory function in patients with maxillary atresia, who have undergone SARME and determining the type of correlation existing between the orthodontic measures and the alterations of area, volume, resistance, and nasal aerial flow. Casuistic and Methods: For the paper accomplishment were assessed 27 adult patients, through acoustic rhinometry, rhinomanometry, orthodontic measures (perimeter and length of maxillary arch, transverse distance among canines, premolars and superior molars) in models of studies and analogical visual scale of only nasal respiratory function, on pre-surgical, after the activation of Hyrax-type maxillary expander, installed previously to the surgery, and after four months of SARME, accomplished under general anesthesia. The otorhinolaryngological tests were accomplished in an environmentally adapted room, with and without the use of nasal vasoconstrictor, in both nasal cavities. Results: The results have demonstrated that 59.3% of the casuistic was of female gender, with an average age of 25.33 years. All the orthodontic measures have obtained a statistically significant growth (p<0.001), which have maintained along the time (p<0.001). All the assessed measures have presented better results with the use of nasal vasoconstrictor. The nasal cavity area as a whole augmented after the surgery (p<0.036). The average volume is 2.75 larger with the vasoconstrictor use (p < 0.001), however, there was any statistically significant alterations between the moments assessed. The expiratory and inspiratory flows have grown along the time (p<0.001, for both). The expiratory pressure is reduced in the course of the moments assessed (p<0.004). The subjective analysis of respiratory sensation only through nose has increased significantly from one moment to the other (p<0.05). There was a statistic correlation between perimeter of augmented arch and aerial resistance diminished (p=0.004) and between the increase of a transverse measure with the growth of inspiratory and expiratory flow, with and without the use of vasoconstrictor (p=0.023 and p=0.004 respectively). Only the respiratory flow presented a different behavior between the sides. Conclusions: Thus, it is concluded that the SARME promotes important alterations on oral and nasal cavities that, associated, generate a better respiratory quality to the patient and demonstrate a clinical otorhinolaryngological relevance of such bucomaxillofacial surgical procedure

La ventilation nasale est vitale pour le nouveau-né, respirateur nasal exclusif. Le tiers antérieur des fosses nasales peut être modifié par une sténose congénitale de l’orifice piriforme, tandis leur partie postérieure peut être fermée par une atrésie choanale uni ou bilatérale ou par des lésions du nasopharynx.Les simulations numériques permettent d’analyser l’écoulement et le conditionnement de l’air en contournant les limites techniques et éthiques rencontrées in vivo. Devant la rareté des données dans la littérature, une étude de faisabilité a été nécessaire et concluante : les modèles numériques sont qualitativement proches de la réalité. Un travail sur les conditions physiologiques chez le nouveau-né a ensuite été réalisé, avec une méthodologie retravaillée. La reconstruction tridimensionnelle des fosses nasales est possible dès la naissance. La création d’une sphère centrée sur la pointe du nez, éloignant le domaine d’entrée de la zone d’intérêt, a permis d’analyser le rôle du tiers antérieur des fosses nasales.La valve nasale joue un rôle majeur en inspiration : perte de charge, accélération, guidage des flux et réchauffement de l’air. Les trois quarts du réchauffement ont lieu en amont du cornet inférieur. Une obstruction nasale entraîne une réduction des vitesses et une augmentation des températures de l'air. La simulation de l’inspiration d’air à 0°C a permis de constater que les fosses nasales permettent d’amortir les effets du refroidissement de l’air extérieur.Ce travail constitue une première approche de la physiologie de la ventilation nasale du nouveau-né par modélisation numérique, indispensable à la compréhension de la pathologie nasale néonatale. / Nasal breathing is essential for the newborn, exclusive nasal breather. The anterior third of the nasal fossae may be modified by a congenital stenosis of the pyriform aperture, while their posterior part may be closed by unilateral or bilateral choanal atresia.Numerical simulations are a good means to analyze airflow and air-conditioning: they circumvent the technical and ethical limits encountered in vivo. Given the rarity of available data in the literature, a feasibility study was necessary and was conclusive: numerical models are qualitatively close to reality. A work on the physiological conditions in newborns was conducted, using refined methodology. The three-dimensional reconstruction of the nasal fossae is possible from birth. The creation of a sphere centered on the tip of the nose, moving the boundary conditions away from the area of interest, made it possible to analyze the role of the anterior third od the nasal fossae.The nasal valve plays a major in inspiration: it is a zone of pressure loss, acceleration, flow guidance and air warming. Three-fourths of the warming takes place upstream the inferior turbinate. A partial nasal obstruction modifies these results with lower velocities and higher temperature of the air. The simulation of the inspiration of cold air (0°C) has shown that the nasal fossae can dampen, without canceling, the effects of air cooling. This work is a first approach to the physiology of nasal ventilation of the newborn by numerical modeling, which is essential to the understanding of neonatal nasal pathology.