Background: Patients with nonallergic irritant rhinitis (NAIR) have symptoms of nasal congestion, nasal irritation, rhinorrhea, and sneezing in response to nasal irritants. We currently have no reliable objective means to quantify these patients' subjective symptoms. In this study, we used the transient receptor potential vanilloid receptor (TRPV1) receptor agonist, capsaicin, as an intranasal challenge while comparing the changes in blood flow with optical rhinometry between subjects with NAIR and healthy controls (HCs). Methods: Six HCs and 6 NAIR subjects were challenged intranasally with saline solution followed by increasing concentrations of capsaicin (0.005 mM, 0.05 mM, and 0.5 mM) at 15-minute intervals. We recorded maximum optical density (OD) and numeric analog scores (NAS) for nasal congestion, nasal irritation, rhinorrhea, and sneezing for each subject after each challenge. Correlations between NAS and maximum OD were calculated. Results: Maximum OD increased with increasing concentrations of intranasal capsaicin in NAIR subjects. There were significant differences in maximum OD obtained for 0.05 mM and 0.5 mM capsaicin between NAIR subjects and HCs. Significant differences were found in the NAS for nasal irritation at 0.005 mM, 0.05 mM, and 0.5 mM, and nasal congestion at 0.5 mM. Correlation between maximum OD and mean NAS was most significant for 0.05 mM capsaicin. Conclusion: Optical rhinometry with intranasal capsaicin challenge could prove a viable option in the diagnosis of NAIR. Further studies will investigate its use to monitor a patient's response to pharmacologic therapy and provide further information about the underlying mechanisms of NAIR.

Background: Patients with nonallergic irritant rhinitis (NAIR) have symptoms of nasal congestion, nasal irritation, rhinorrhea, and sneezing in response to nasal irritants. We currently have no reliable objective means to quantify these patients' subjective symptoms. In this study, we used the transient receptor potential vanilloid receptor (TRPV1) receptor agonist, capsaicin, as an intranasal challenge while comparing the changes in blood flow with optical rhinometry between subjects with NAIR and healthy controls (HCs). Methods: Six HCs and 6 NAIR subjects were challenged intranasally with saline solution followed by increasing concentrations of capsaicin (0.005 mM, 0.05 mM, and 0.5 mM) at 15-minute intervals. We recorded maximum optical density (OD) and numeric analog scores (NAS) for nasal congestion, nasal irritation, rhinorrhea, and sneezing for each subject after each challenge. Correlations between NAS and maximum OD were calculated. Results: Maximum OD increased with increasing concentrations of intranasal capsaicin in NAIR subjects. There were significant differences in maximum OD obtained for 0.05 mM and 0.5 mM capsaicin between NAIR subjects and HCs. Significant differences were found in the NAS for nasal irritation at 0.005 mM, 0.05 mM, and 0.5 mM, and nasal congestion at 0.5 mM. Correlation between maximum OD and mean NAS was most significant for 0.05 mM capsaicin. Conclusion: Optical rhinometry with intranasal capsaicin challenge could prove a viable option in the diagnosis of NAIR. Further studies will investigate its use to monitor a patient's response to pharmacologic therapy and provide further information about the underlying mechanisms of NAIR.

Objectives: To investigate whether any changes in nasal cavity dimensions or subjective report of nasal symptoms exist after rapid maxillary expansion using two types of expansion appliances, comparing results with an untreated control group. Methods: Subjects were randomly assigned into one of three groups: tooth-borne or bone-anchored expander or untreated control. Acoustic rhinometry was used to measure minimal cross-sectional area and volume of the nasal cavity over three timepionts for treatment subjects and two timepoints for control subjects, taken along with the NOSE Instrument survey. Results: No significant changes in nasal cavity dimension or subjective reports were found in subjects treated with tooth- or bone-anchored appliances compared to control subjects over three timepoints. In addition, non-significant correlation was observed between nasal airway dimensional change and subject symptoms. Conclusions: Rapid maxillary expansion does not result in change of i) nasal airway dimensions or ii) the sensation of nasal symptoms. / Orthodontics

No description available.

PURPOSE: To determine the prevalence of Sleep Disturbances (SD) in children and to evaluate the correlation between dental classification and airway dimensions. METHODS: Children between 3 – 18 years at the Boston University Pediatric Oral Healthcare Center in Boston, Massachusetts were recruited for this study. Based on parents’ responses in a brief sleep-screening questionnaire, cases were identified as children with SD and controls were those without. Another detailed questionnaire was used to collect information on demographics and sleep patterns. Clinical and upper airway examinations were conducted using Eccovision Acoustic Rhinometer (AR) and Acoustic Pharyngometer (AP). Statistical differences in upper airway measurements by type of dental occlusion were evaluated. RESULTS: Among 281 children, the prevalence of SD was 38%. Upper airway measurements among 176 participants using AP showed significantly higher pharyngeal Minimum Cross-Sectional Area (MCA) for class III dental occlusion compared to class I (P=.036) in children with SD. Statistically significant differences in MCA, Airway Volume (AV), and minimum distance to MCA by type of dental occlusion were mainly observed among children with SD (P<.05). CONCLUSIONS: The results highlight a possible correlation between nasal and pharyngeal airway dimensions and dental classification among children with SD. Further analysis that include radiological examinations may help in confirming these findings.

Objetivo: Verificar se a rinometria acústica, usada de rotina para avaliar a patência nasal, é capaz de identificar a deficiência no movimento velar em indivíduos com diagnóstico clínico de função velofaríngea inadequada (FVI). Modelo: Estudo clínico prospectivo Local de Execução: Hospital de Referência Especializado. Participantes: Vinte indivíduos com fissura de palato reparada e FVI residual e 18 indivíduos-controle sem fissura de palato e função velofaríngea adequada (FVA), adultos, de ambos os sexos. Variáveis analisadas: Curvas área-distância foram obtidas no repouso velar e na fala (fonema /k/), utilizando um sistema Eccovision AR, sendo o volume determinado pela integração da área sob a curva em segmento correspondente à nasofaringe. A mobilidade velar (V) foi estimada pela diferença absoluta e relativa entre o volume nasofaríngeo no repouso velar (Vr) e na fala (Vk). A eficiência da técnica em discriminar FVI e FVA foi analisada pela curva ROC. Resultados: Os valores médios (±DP) de Vr e Vk obtidos foram: 23,2±3,6cm3 e 15,9±3,8cm3, no grupo FVA, e 22,7±7,9cm3 e 20,7±7,4cm3, no grupo FVI, correspondendo a uma redução média de 7,3cm3 (31%) no grupo FVA e a uma redução significativamente menor, de 2,0cm3 (9%), no grupo FVI (p<0,05). Constatou-se que 70% dos pacientes do grupo FVI apresentaram V sugestivo de elevação velar prejudicada (inferior ao limiar de corte que maximizou, simultaneamente, a sensibilidade e a especificidade do teste), confirmando o diagnóstico clínico. Conclusão: A rinometria acústica foi capaz de identificar, com bom poder discriminatório, o comprometimento da atividade velar que caracteriza a insuficiência velofaríngea. / Objective: To determine whether acoustic rhinometry, routinely used for evaluation of nasal patency, is able to identify impairment of velar movement in individuals with clinical diagnosis of inadequate velopharyngeal function (IVF). Design: Prospective clinical study. Setting: Reference Craniofacial Hospital. Participants: Twenty subjects with repaired cleft palate and residual IVF and 18 noncleft controls with adequate velopharyngeal function (AVF), adults, of both sexes. Main Outcomes Measures: Area-distance curves were obtained during velar rest and speech (phoneme /k/), using an Eccovision AR system, and volume was determined by integrating the area under the curve at a segment corresponding to nasopharynx. Velar mobility (_V) was estimated by the absolute and relative difference between nasopharyngeal volume at velar rest (Vr) and speech (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6cm3 and 15.9±3.8cm3 (AVF group), and 22.7±7.9cm3 and 20.7±7.4cm3 (IVF group), corresponding to an average reduction of 7.3cm3 (31%) for the AVF group and a significantly smaller reduction of 2.0cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF patients showed a _V suggesting impaired velar elevation (below the cutoff score that maximized both the sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of velar activity which characterizes velopharyngeal insufficiency.

Objetivo: Verificar se a rinometria acústica, usada de rotina para avaliar a patência nasal, é capaz de identificar a deficiência no movimento velar em indivíduos com diagnóstico clínico de função velofaríngea inadequada (FVI). Modelo: Estudo clínico prospectivo Local de Execução: Hospital de Referência Especializado. Participantes: Vinte indivíduos com fissura de palato reparada e FVI residual e 18 indivíduos-controle sem fissura de palato e função velofaríngea adequada (FVA), adultos, de ambos os sexos. Variáveis analisadas: Curvas área-distância foram obtidas no repouso velar e na fala (fonema /k/), utilizando um sistema Eccovision AR, sendo o volume determinado pela integração da área sob a curva em segmento correspondente à nasofaringe. A mobilidade velar (V) foi estimada pela diferença absoluta e relativa entre o volume nasofaríngeo no repouso velar (Vr) e na fala (Vk). A eficiência da técnica em discriminar FVI e FVA foi analisada pela curva ROC. Resultados: Os valores médios (±DP) de Vr e Vk obtidos foram: 23,2±3,6cm3 e 15,9±3,8cm3, no grupo FVA, e 22,7±7,9cm3 e 20,7±7,4cm3, no grupo FVI, correspondendo a uma redução média de 7,3cm3 (31%) no grupo FVA e a uma redução significativamente menor, de 2,0cm3 (9%), no grupo FVI (p<0,05). Constatou-se que 70% dos pacientes do grupo FVI apresentaram V sugestivo de elevação velar prejudicada (inferior ao limiar de corte que maximizou, simultaneamente, a sensibilidade e a especificidade do teste), confirmando o diagnóstico clínico. Conclusão: A rinometria acústica foi capaz de identificar, com bom poder discriminatório, o comprometimento da atividade velar que caracteriza a insuficiência velofaríngea. / Objective: To determine whether acoustic rhinometry, routinely used for evaluation of nasal patency, is able to identify impairment of velar movement in individuals with clinical diagnosis of inadequate velopharyngeal function (IVF). Design: Prospective clinical study. Setting: Reference Craniofacial Hospital. Participants: Twenty subjects with repaired cleft palate and residual IVF and 18 noncleft controls with adequate velopharyngeal function (AVF), adults, of both sexes. Main Outcomes Measures: Area-distance curves were obtained during velar rest and speech (phoneme /k/), using an Eccovision AR system, and volume was determined by integrating the area under the curve at a segment corresponding to nasopharynx. Velar mobility (_V) was estimated by the absolute and relative difference between nasopharyngeal volume at velar rest (Vr) and speech (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6cm3 and 15.9±3.8cm3 (AVF group), and 22.7±7.9cm3 and 20.7±7.4cm3 (IVF group), corresponding to an average reduction of 7.3cm3 (31%) for the AVF group and a significantly smaller reduction of 2.0cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF patients showed a _V suggesting impaired velar elevation (below the cutoff score that maximized both the sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of velar activity which characterizes velopharyngeal insufficiency.

Introdução: A evolução das técnicas de rinoplastia está intimamente relacionada com o melhor conhecimento anatômico e funcional do nariz. A observação de que a incompetência das válvulas nasais pode ser responsável por até 50 por cento das queixas obstrutivas vem sendo confirmada através de diversos estudos. A utilização de enxertos expansores (spreader grafts) para ampliação das válvulas internas já foi bem estabelecida, no entanto, ainda não foi bem estudada de forma objetiva. Objetivo: A finalidade deste estudo foi avaliar prospectivamente a utilização de enxertos expansores na rinoplastia, fazendo-se uma análise objetiva do grau de melhora da patência nasal dos pacientes através da rinometria acústica e do espelho de Glatzel modificado, bem como uma análise subjetiva da qualidade de respiração dos mesmos pacientes mediante um escore preestabelecido. Metodologia: Foram estudados vinte pacientes submetidos à rinoplastia com utilização de enxertos expansores. Os pacientes foram avaliados no pré-operatório através de análise subjetiva através de questionário de qualidade respiratória - e objetiva, através de medidas da área de secção mínima transversa correspondente à válvula nasal interna mediante a rinometria acústica, e, através do espelho de Glatzel modificado. Após 90 a 120 dias da cirurgia, novas medidas foram realizadas, comparando-as com os resultados obtidos no pré-operatório. Os valores obtidos foram abordados sob a forma de variáveis quantitativas e analisados de acordo com a média e o desvio-padrão pelo teste não paramétrico de Wilcoxon. Conclusão: As medidas referentes às válvulas internas obtidas mediante rinometria acústica foram superiores quando comparados o momento pós-operatório com o pré-operatório dos lados direito e esquerdo. Quando analisados os valores obtidos através do espelho de Glatzel modificado, também observou-se que houve um acréscimo das médias se comparado o pós com o pré-operatório. A análise subjetiva da sensação de patência nasal demonstrou uma melhora na qualidade respiratória e apresentou significância estatística / Background: The evolution of rhinoplasty techniques is closely related to the best knowledge of anatomy and function of the nose. The observation that the nasal valve incompetence may be responsible for up to 50 percent of obstructive symptoms has been confirmed by several studies. Using spreader grafts for internal valves expansion has been well established; however, it has not been well studied objectively. Objective: The purpose of this study was to prospectively evaluate the use of spreader grafts during rhinoplasty. We analyzed objectively the improvement degree in the nasal patency of patients through acoustic rhinometry and modified Glatzels mirror. We also analyzed the subjective improvement degree through a breathing quality score. Method: We studied twenty patients undergoing rhinoplasty with spreader grafts. Patients were evaluated preoperatively through subjective means-by a quality in breathing questionnaire-and objective analysis, by measuring the minimum cross sectional area (corresponding to the internal nasal valve) by acoustic rhinometry and through a modified Glatzels mirror. After 90 to 120 days, new measurements were made and then compared with those obtained preoperatively. The values were addressed in the form of quantitative variables and analyzed according to the mean and standard deviation by the nonparametric Wilcoxon test. Conclusion: The measures relating to the internal valves obtained by acoustic rhinometry were higher when the moment after surgery was compared with the preoperative moment on the left and the right sides. The results obtained by the modified Glatzels mirror also showed an increase in the measures in both sides. Analysis of subjective sensation of nasal patency demonstrated an improvement in quality of breathing with statistical significance

O objetivo neste trabalho foi de analisar a geometria nasal, a nasofaringe e a orofaringe, em crianças respiradoras orais com indicação de cirurgia desobstrutiva das vias aéreas superiores, e verificar a existência de uma possível influência direta da respiração na determinação do tipo facial. Foram avaliadas 657 crianças e, dentre elas, foram selecionadas 75, que se submeteram a avaliação otorrinolaringológica por meio de exames clínico, de radiografia cavum e/ou nasofibroscopia, e com as quais ficaram evidenciadas as obstruções das vias aéreas superiores com indicação cirúrgica. Ao final 41 crianças (21 do gênero masculino e 20 do feminino), entre 6,16 e 14,66 anos de idade, brasileiras, leucodermas, sem história de tratamento ortodôntico ou otorrinolaringológico cirúrgico (remoção de tonsilas faringeanas, palatinas, ou estruturas internas da cavidade nasal), aceitaram participar do estudo. Foram obtidas telerradiografias em norma lateral para a determinação do tipo facial e realizado o exame de rinometria acústica para a obtenção da área transversal mínima da cavidade nasal. A análise estatística dos dados (ANOVA, Razão de Verossimilhanças, análises de variâncias com medidas repetidas com dois fatores, comparações múltiplas de Bonferroni, teste Kruskal- Wallis; com nível de significância de 5%) e a interpretação dos resultados obtidos não mostraram diferença estatisticamente significativa na área total em MCA1 e MCA2 entre os tipos faciais (p > 0,05). Além disso, a obstrução das tonsilas faringeanas e palatinas avaliadas separadamente ou combinadas não variou estatisticamente segundo os tipos faciais (p = 0,582 para tonsila faringeana e p = 0,733 para tonsila palatina; e p = 0,925 quando combinadas). Conclui-se que, no presente estudo, não foi encontrada evidência de que a obstrução das vias aéreas superiores tenha influência determinante na definição do tipo facial. / The objective of this paper was to analyze the nasal geometry, the nasopharynx and the oropharynx in oral breathing children with indication for surgery clearence upper airway, in order to verify the existence of a possible direct influence of breathing in the determination of the facial type. A group of 657 children was evaluated and, among them, 75 were selected for otorhinolaryngologic evaluation through clinical exams, cavum radiography and/or nasal endoscopy , when the obstruction of the upper airway with surgical indication has been confirmed. From this subgroup, 41 children agreed to participate in the study (21 males: 20 females), with ages between 6,16 and 14,66 years, brazilians, whites, with no history of orthodontic treatment nor otorhinolaryngologic surgery (removal of the pharyngeal or palatine tonsils or internal structures of the nasal cavity). Radiographs were taken in lateral norm for the determination of the facial type and the acoustic rhinometry exam was performed for the determination of the nasal minimal transversal area. The statistical analyses of the data were made with the variance analysis (ANOVA), likelihood ratio test, analyses of variance with measures repeated with two factors, Bonferroni multiple comparisons, and Kruskal-Wallis test. The significance level was chosen as 0.05. No statistically significant difference was detected in the total area in MCA1 and MCA2 between the facial types. Besides that, the obstruction of the pharyngeal or palatine tonsils, taken separately or in combination, did not vary statistically according to the facial pattern (p = 0.582 for pharyngeal tonsil; p = 0.733 for palatine tonsil; and p = 0.925 when combined). Therefore, in the present study, no evidence has been found that the obstruction of the superior airway has determinant influence in the determination of the facial type.

Objetivo: Determinar as áreas seccionais e os volumes de segmentos específicos da cavidade nasal, incluindo a nasofaringe, de indivíduos sem evidências de obstrução nasal, e os mesmos volumes na produção da fala, com vistas ao estabelecimento de valores de referência. Modelo: Análise prospectiva. Local de Execução: Laboratório de Fisiologia, HRAC-USP. Participantes: 30 voluntários caucasianos, com idade entre 18 e 30 anos, sendo 14 homens e 16 mulheres. Intervenções/Variáveis: Foram avaliadas, por rinometria acústica, áreas de secção transversa nos segmentos correspondentes à válvula nasal (AST1), região anterior da concha nasal inferior (AST2) e região posterior da concha nasal inferior (AST3) e volumes, nos segmentos correspondentes à região da válvula nasal (V1), dos cornetos (V2) e da nasofaringe (V3). As medidas foram feitas antes e após a descongestão nasal, no repouso (suspensão voluntária da respiração) e durante a atividade velofaríngea (produção contínua e silenciosa do fonema /f/). Resultados: Os valores médios (±DP) das áreas (em cm2) e volumes (em cm3) obtidos no repouso, foram: AST1=0,54±0,13, AST2=0,98±0,31, AST3=1,42±0,44, V1=1,68±0,32, V2=3,98±1,12 e V3=18,93±3,51. Após a DN os valores foram significantemente maiores (p<0,05). Na fala, os volumes foram os seguintes: V1=1,80±0,22; V2=4,22±1,20; V3=15,32±5,40. O valor de V3 na fala foi significantemente menor que o observado na ausência de atividade velofaríngea (p<0,05). Conclusão: A comparação das áreas seccionais e dos volumes obtidos com os relatados na literatura validam seu uso como valores de referência, assim como o emprego da rinometria acústica como método de avaliação objetiva da geometria nasal e da atividade velofaríngea na fala. / Objective: To determine cross-sectional areas and volumes of specific segments of the nasal cavity, including the nasopharyngeal region, of individuals without evidences of nasal obstruction, and the same volumes during speech, with the purpose of establishing reference values. Model: Prospective analysis. Setting: Laboratory of Physiology, HRAC-USP. Participants: 30 caucasians volunteers, aged between 18 and 30 years (14 males and 16 females). Intervention/Variables: Cross-sectional areas corresponding to the nasal valve (CSA1), anterior edge of the inferior turbinate (CSA2) and posterior edge of the inferior turbinate (CSA3), and volumes corresponding to the nasal valve (V1), turbinate (V2) and nasopharyngeal regions (V3) were evaluated. Measurements were performed by acoustic rhinometry before and after nasal decongestion, at rest (voluntary interruption of respiration) and during velopharyngeal activity (silent continuous production of the sound /f/). Results: Mean values (±SD) of areas (in cm2) and volumes (in cm3) were the following: CSA1=0,54±0,13, CSA2=0,98±0,31, CSA3=1,42±0,44, V1=1,68±0,32, V2=3,98±1,12 and V3=18,93±3,51. After decongestion, the values were significantly larger (p<0,05). During speech, volumes were the following: V1=1,80±0,22; V2=4,22±1,20; V3=15,32±5,40. Nasopharyngeal volume (V3) measured during speech was significantly smaller than at rest (p<0,05). Conclusion: The comparison of the nasal cross-sectional areas and volumes obtained with those reported in the literature validate their use as reference values and the use of acoustic rhinometry to assess nasal geometry and velopharyngeal activity during speech.