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Normal nasal patency: problems in obtaining standard reference values for the surgeon

Published online by Cambridge University Press:  12 April 2012

M Moore  and
R Eccles
M Moore*
Affiliation:
Common Cold Centre, Cardiff University, Wales, UK
R Eccles
Affiliation:
Common Cold Centre, Cardiff University, Wales, UK
*
Address for correspondence: Mr Matthew Moore, ENT Research Fellow, Common Cold Centre, Cardiff University, Cardiff CF10 3AX, Wales, UK Fax: +44 (0)29 20 874093 E-mail: [email protected]
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Abstract

This review examines why there is no normal range of nasal patency available to the surgeon when assessing nasal obstruction, and discusses the factors that influence nasal patency. Current normal ranges are examined and criticised because of the variability of normal values and the poor sampling methods used. Instability of physiological nasal patency is related to factors such as the nasal cycle and the nose's direct exposure to the external environment. Decongestion of the nose is proposed as a way of stabilising anatomical nasal patency, and measurements of patency in this state may be more useful to the surgeon. Population studies are needed to establish a normal range, but these studies must control for factors such as age, height, sex, and nasal shape and size related to climatic adaptation. Rather than classify populations according to unscientific categories such as race, anthropometric measures such as the nasal index are proposed.

Keywords

Nasal ObstructionNasal IndexNasal PatencyRhinologyRaceNasal Cycle
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 6 , June 2012 , pp. 563 - 569
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Holmström, M. The use of objective measures in selecting patients for septal surgery. Rhinology 2010;48:387–93CrossRefGoogle ScholarPubMed
2Johnston, S, Holgate, S. Epidemiology of viral respiratory infections. In: Myint, S, Taylor-Robinson, D, eds. Viral and Other Infections of the Human Respiratory Tract. London: Chapman & Hall, 1996;1–38Google Scholar
3Heetderks, DL. Observations on the reaction of normal nasal mucous membrane. Am J Med Sci 1927;174:231–44CrossRefGoogle Scholar
4Stoksted, P. Rhinometric measurements for determination of the nasal cycle. Acta Otolaryngol Suppl 1953;109:159–75CrossRefGoogle ScholarPubMed
5Stoksted, P. The physiologic cycle of the nose under normal and pathologic conditions. Acta Otolaryngol 1952;42:175–9CrossRefGoogle ScholarPubMed
6Flanagan, P, Eccles, R. Spontaneous changes of unilateral nasal airflow in man. A re-examination of the ‘nasal cycle’. Acta Otolaryngol 1997;117:590–5CrossRefGoogle Scholar
7Cole, P. Nasal airflow resistance: a survey of 2500 assessments. Am J Rhinol 1997;11:415–20CrossRefGoogle ScholarPubMed
8Broms, P. Rhinomanometry. III. Procedures and criteria for distinction between skeletal stenosis and mucosal swelling. Acta Otolaryngol 1982;94:361–70CrossRefGoogle ScholarPubMed
9Soubeyrand, L. Action of vasomotor drugs on the nasal cycle and ciliary function (rhinometric and biological study) [in French]. Rev Laryngol Otol Rhinol (Bord) 1964;85:49–113Google Scholar
10Dallimore, NS, Eccles, R. Changes in human nasal resistance associated with exercise, hyperventilation and rebreathing. Acta Otolaryngol 1977;84:416–21CrossRefGoogle ScholarPubMed
11Papachristou, A, Bourli, E, Aivazi, D, Futzila, E, Papastavrou, T, Konstandinidis, T et al. Normal peak nasal inspiratory flow rate values in Greek children and adolescents. Hippokratia 2008;12:94–7Google ScholarPubMed
12Ottaviano, G, Scadding, GK, Coles, S, Lund, VJ. Peak nasal inspiratory flow; normal range in adult population. Rhinology 2006;44:32–5Google ScholarPubMed
13Postema, CA, Huygen, PL, Lecluse, RG, Wentges, RT. The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry. Clin Otolaryngol Allied Sci 1980;5:165–70CrossRefGoogle ScholarPubMed
14Millqvist, E, Bende, M. Reference values for acoustic rhinometry in subjects without nasal symptoms. Am J Rhinol 1998;12:341–3CrossRefGoogle ScholarPubMed
15Shelton, DM, Eiser, NM. Evaluation of active anterior and posterior rhinomanometry in normal subjects. Clin Otolaryngol Allied Sci 1992;17:178–82CrossRefGoogle ScholarPubMed
16Suzina, AH, Hamzah, M, Samsudin, AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol 2003;117:609–13CrossRefGoogle ScholarPubMed
17Abramson, Z, Susarla, S, Troulis, M, Kaban, L. Age-related changes of the upper airway assessed by 3-dimensional computed tomography. J Craniofac Surg 2009;20(suppl 1):657–63CrossRefGoogle ScholarPubMed
18Lindemann, J, Sannwald, D, Wiesmiller, K. Age-related changes in intranasal air conditioning in the elderly. Laryngoscope 2008;118:1472–5CrossRefGoogle ScholarPubMed
19Lindemann, J, Tsakiropoulou, E, Konstantinidis, I, Lindemann, K. Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx 2010;37:303–7CrossRefGoogle Scholar
20Sforza, C, Grandi, G, De Menezes, M, Tartaglia, GM, Ferrario, VF. Age- and sex-related changes in the normal human external nose. Forensic Sci Int 2011;204:205CrossRefGoogle ScholarPubMed
21Prescott, CA, Prescott, KE. Peak nasal inspiratory flow measurement: an investigation in children. Int J Pediatr Otorhinolaryngol 1995;32:137–41CrossRefGoogle ScholarPubMed
22Jessen, M, Malm, L. Use of pharmacologic decongestion in the generation of rhinomanometric norms for the nasal airway. Am J Otolaryngol 1988;9:336–40CrossRefGoogle ScholarPubMed
23Bloom, JW, Kaltenborn, WT, Quan, SF. Risk factors in a general population for snoring. Importance of cigarette smoking and obesity. Chest 1988;93:678–83CrossRefGoogle Scholar
24Crouse, U, Laine-Alava, MT. Effects of age, body mass index, and gender on nasal airflow rate and pressures. Laryngoscope 1999;109:1503–8CrossRefGoogle ScholarPubMed
25Ohki, M, Naito, K, Cole, P. Dimensions and resistances of the human nose: racial differences. Laryngoscope 1991;101:276–8CrossRefGoogle ScholarPubMed
26Thomson, A, Dudley Buxton, LH. Man's nasal index in relation to certain climatic conditions. The Journal of the Royal Anthropological Institute of Great Britain and Ireland 1923; 53:92–122CrossRefGoogle Scholar
27Wolpoff, MH. Climatic influence on the skeletal nasal aperture. Am J Phys Anthropol 1968;29:405–23CrossRefGoogle ScholarPubMed
28Calhoun, KH, House, W, Hokanson, JA, Quinn, FB. Normal nasal airway resistance in noses of different sizes and shapes. Otolaryngol Head Neck Surg 1990;103:605–9CrossRefGoogle ScholarPubMed
29Corey, JP, Gungor, A, Nelson, R, Liu, X, Fredberg, J. Normative standards for nasal cross-sectional areas by race as measured by acoustic rhinometry. Otolaryngol Head Neck Surg 1998;119:389–93CrossRefGoogle Scholar
30Jones, AG, Bhatia, S. A study of nasal respiratory resistance and craniofacial dimensions in white and West Indian black children. Am J Orthod Dentofacial Orthop 1994;106:34–9CrossRefGoogle ScholarPubMed
31Canbay, EI, Bhatia, SN. A comparison of nasal resistance in white Caucasians and blacks. Am J Rhinol 1997;11:73–5CrossRefGoogle ScholarPubMed
32Leong, SC, Eccles, R. A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology. Clin Otolaryngol 2009;34:191–8CrossRefGoogle ScholarPubMed
33Leong, SC, Eccles, R. The use of race as a demographic variable in clinical research. Rhinology 2010;48:3–6Google Scholar
34Jalowayski, AA, Yuh, YS, Koziol, JA, Davidson, TM. Surgery for nasal obstruction – evaluation by rhinomanometry. Laryngoscope 1983;93:341–5CrossRefGoogle ScholarPubMed
35Szücs, E, Clement, PA. Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patients with nasal septal deviation. Am J Rhinol 1998;12:345–52CrossRefGoogle ScholarPubMed
36Sipilä, JI, Suonpää, JT, Kortekangas, AE, Laippala, PT. Rhinomanometry before septoplasty – an approach to clinical material with diverse nasal symptoms. Am J Rhinol 1992;6:17–22CrossRefGoogle Scholar
37Gordon, AS, McCaffrey, TV, Kern, EB, Pallanch, JF. Rhinomanometry for preoperative and postoperative assessment of nasal obstruction. Otolaryngol Head Neck Surg 1989;101:20–6CrossRefGoogle ScholarPubMed
38Kenyon, GS. Phase variation in nasal airways resistance assessed by active anterior rhinomanometry. J Laryngol Otol 1987;101:910–16CrossRefGoogle ScholarPubMed
39Szücs, E, Kaufman, L, Clement, PA. Nasal resistance – a reliable assessment of nasal patency? Clin Otolaryngol Allied Sci 1995;20:390–5CrossRefGoogle ScholarPubMed
40McCaffrey, TV, Kern, EB. Clinical evaluation of nasal obstruction. A study of 1,000 patients. Arch Otolaryngol 1979;105:542–5CrossRefGoogle Scholar
41Pallanch, JF, McCaffrey, TV, Kern, EB. Normal nasal resistance. Otolaryngol Head Neck Surg 1985;93:778–5CrossRefGoogle ScholarPubMed
42Shelton, DM, Pertuze, J, Gleeson, MJ, Thompson, J, Denman, WT, Goff, J et al. Comparison of oscillation with three other methods for measuring nasal airways resistance. Respir Med 1990;84:101–6CrossRefGoogle ScholarPubMed
43Gammert, C, Hampl, K, Herrmann, P. Normal values in rhinomanometry [in German]. HNO 1988;36:399–405Google ScholarPubMed
44Gleeson, MJ, Youlten, LJ, Shelton, DM, Siodlak, MZ, Eiser, NM, Wengraf, CL. Assessment of nasal airway patency: a comparison of four methods. Clin Otolaryngol Allied Sci 1986;11:99–107CrossRefGoogle ScholarPubMed
45Eiser, N. The hitch-hikers guide to nasal airway patency. Respir Med 1990;84:179–83CrossRefGoogle ScholarPubMed
46Risavi, R, Pisl, Z, Sprem, N, Klapan, I. Rhinomanometrical findings after septoplasty in children. Int J Pediatr Otorhinolaryngol 1988;16:149–55CrossRefGoogle ScholarPubMed
47Zapletal, A, Chalupová, J. Nasal airflow and resistance measured by active anterior rhinomanometry in healthy children and adolescents. Pediatr Pulmonol 2002;33:174–80CrossRefGoogle ScholarPubMed
48Davies, A. Man's nasal index in relation to climate. Man 1929;29:8–14CrossRefGoogle Scholar
49Franciscus, RG, Long, JC. Variation in human nasal height and breadth. Am J Phys Anthropol 1991;85:419–27CrossRefGoogle ScholarPubMed
50Bhopal, R, Donaldson, L. White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. Am J Public Health 1998;88:1303–7CrossRefGoogle ScholarPubMed
51Leong, SC, Eccles, R. Race and ethnicity in nasal plastic surgery: a need for science. Facial Plast Surg 2010;26:63–8CrossRefGoogle ScholarPubMed
52Crapo, RO. The role of reference values in interpreting lung function tests. Eur Respir J 2004;24:341–2CrossRefGoogle ScholarPubMed
53Kiviranta, K, Haahtela, T. Caucasian race and lung function: time to revisit the racial groups used in reference values. Eur Respir J 2006;28:1280CrossRefGoogle ScholarPubMed
54Golshan, M, Amra, B, Soltani, F, Crapo, RO. Reference values for lung volumes in an Iranian population: introducing a new equation model. Arch Iran Med 2009;12:256–61Google Scholar