[Relations between chronic nasal obstruction, nasal allergy and bronchial asthma].
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Acoustic Impedance Tests↗
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Impact and modulation of nasal obstruction.
Nasal obstruction, the leading symptom of allergic rhinitis, results from the combined activity of early- and late-phase allergic reactions. Desloratadine inhibits both early- and late-phase inflammatory mediators in vitro. Thus, double-blind, placebo-controlled, randomized, crossover trials were conducted to assess the efficacy of desloratadine against nasal obstruction, measured objectively and subjectively, during controlled exposure of patients with seasonal allergic rhinitis to allergen. Positive results were obtained in three single-dose studies; desloratadine 5 mg resulted in a greater improvement from baseline than did placebo in the total symptom score and the nasal obstruction symptom score (P </= 0.02). Desloratadine was more effective than placebo in a multiple-dose study; desloratadine 5 mg was given once daily for 7 days, and a 6-h allergen challenge was administered at the end of treatment compared with placebo. Desloratadine treatment was associated with less deterioration from baseline in the mean nasal airflow (P < 0.05) and in the mean severity score for the symptom of nasal obstruction (P < 0.03). Desloratadine significantly reduces the severity of nasal obstruction in patients with seasonal allergic rhinitis.
Histamine H1 Antagonists↗
Endoscopy in the assessment of children with nasal obstruction.
Nasal obstruction is common in children, and is often attributed to adenoid enlargement. This prospective study was performed to determine whether routine nasal endoscopy is of value for children undergoing surgery for nasal obstruction. Forty-eight children aged two to nine years undergoing adenoidectomy, and six normal controls, were examined under general anaesthesia with a 4 mm rigid endoscope. A video of the endoscopy was subsequently assessed independently by an observer blinded to the original findings and the presence of nasal symptoms. The endoscopist and independent assessor were in agreement regarding 86 per cent of the findings. Three quarters of the children had abnormalities on endoscopy in addition to enlarged adenoids, and in 23 per cent these were potentially of major clinical significance (unsuspected foreign body, gross septal deviation, gross hypertrophy of the turbinates). Endoscopy produced no post-operative complications and was possible in children as young as two years of age, without decongestants. Nasal endoscopy is a safe, objective and useful means of identifying potentially significant abnormalities in children with nasal obstruction.
Adenoidectomy↗
The systemic effects of nasal obstruction.
Nasal obstruction has profound effects on the body as a whole. Occasionally, these effects dominate the patient's symptoms and complaints and should be recognized as part of the nasal obstruction syndrome. A thorough understanding of their relationship with nasal obstruction will provide reassurance to the patient and allow for their resolution.
Airway Obstruction↗
Treatment of nasal obstruction from nasal valve collapse with alar batten grafts.
Nasal obstruction may require treatment with rhinoplasty techniques. One cause of nasal obstruction is known as nasal valve collapse. This refers to narrowness and weakness at the nasal valve, the narrowest part of the nasal airway. There are a number of surgical approaches available to treat nasal valve collapse. Selection of the appropriate surgical intervention depends on proper identification of the anatomic cause of the collapse. Alar batten grafts are especially useful for addressing nasal valve collapse caused by a weak nasal sidewall. In this report, we review the senior author's experience with the use of alar batten grafts for nasal valve collapse. Twenty-one patients had septoplasty with placement of alar batten grafts; all patients noted improvement in their nasal breathing. Seven patients underwent ear cartilage harvest with alar batten grafts, and five of them noted improvement, one noted partial improvement, one noted no improvement. Six patients underwent revision septorhinoplasty with alar batten grafting, and ten patients underwent revision septorhinoplasty with ear cartilage harvest and alar batten grafting. These patients all reported improvement in their nasal breathing postoperatively. Six patients underwent revision rhinoplasty (no septoplasty) with ear cartilage and battens. These patients hold special interest because no other intranasal procedures were performed that affected nasal breathing. All six of these patients reported significant improvement of their nasal breathing and all patients were satisfied with their postsurgical cosmetic appearance. The nasal valve area is considered to be the location of the least cross-sectional area in the nose. When narrowing of the nasal valve is a result of collapse of the nasal sidewall, alar batten grafts are a useful technique to address the patient's nasal obstruction.
Female↗
Nasal septal perforations and nasal obstruction.
Nasal septal perforations cause a wide range of symptoms that vary from mild discomfort and nasal obstruction to life-threatening epistaxis. The differential diagnosis, pathophysiology, and treatment of this disorder are reviewed.
Airway Obstruction↗
Nasal obstruction portending nasal cavity cancer.
This report demonstrates why all patients presenting with persistent nasal obstruction should be completely evaluated because of the difficulty in diagnosing nasal chamber tumors.
Adult↗
[Endoscopic surgery of turbinates and nasal obstruction].
Nasal blockage is one of the most habitual symptoms in otolaryngologist office and the concha nasalis inferior hypertrophy the commonest cause of the trouble. Cases in which medical treatment is refractory, surgery could be an optional resort in accordance of a great deal of specialists. The possibility of give rise to atrophic rhinitis or even ozenatous lesions has been refraining this surgery lately. In our series are contemplated the outcomes of several surgical procedures as mode of management of the hypertrophy of the lower turbinal. In the article are assessed the results of several surgical techniques dealing with hypertrophy of concha nasalis inferior. 75 patients were operated under endoscopic control. Some underwent a submucous decompression (SD) other partial resection (PR). Results at half and long term of both techniques-the conservative one (SD) and that a little more aggressive (PR)-are compared, and so are the factors conditioning the selection of the surgical procedure done. We consider the partial resection of the inferior concha, under endoscopic vision, as the best way for improving the nose obstruction due to inferior concha hypertrophy, provided conservative measures are not wise at all. Furthermore because with our own hands we reach very good outcomes, both in breathing and nasal comfort. Only the patient's age may influence the last decision.
Adolescent↗
Ultrastructural ciliary findings in nasal obstructive diseases.
Specific ultrastructural findings have widely been described in case of obstructive nasal diseases due to congenital defects. Ciliary impairment has in particular been observed as the main pathological feature in these conditions. In this study, nasal mucosal samples from different pathologies have been collected via the "brushing" technique and analysed by transmission electron microscopy. TEM analysis was focused on specific features, such as the numerical array of peripheral and central doublets of the cilium axoneme, including eventual microtubular disarrangement; partial or total loss of inner and/or outer dynein arms; defects of radial spokes and nexin links; disorientation of the ciliary axis in closely adjacent cilia, calculating the angle between the line crossing the central microtubular core and the horizontal ciliary axis and compound cilia (CC). Statistical comparison was carried out between study and control groups. A significant incidence of organic ciliary defects was found not only in patients with inflammatory processes, but mostly in those supposed to have a long-lasting nasal respiratory disease due to mechanical stenosis in relation to septum deviation and turbinate hypertrophy. Prevalence and percentage of compound cilia were instead more related to inflammatory conditions. The "brushing" technique can be considered an easy and reliable method for the assessment of the condition of the nasal mucosa. According to the findings derived from this study, mechanical nasal obstruction seems to cause major alterations on the nasal ciliary arrangement, thus determining a functional impairment on the whole nasal function.
Adult↗
Nasal obstruction. The nasal septum and concha bullosa.
Nasal septal defects impair nasal physiology, leading to progressively more severe rhinosinusitis and the development of chronic disease. Anatomy and physiology are described. Treatment for the deviated nasal septum is discussed.
Airway Obstruction↗
Assessment of nasal obstruction with flexible nasal endoscopy.
OBJECTIVE: To report the value of nasal endoscopy as an outpatient procedure in the diagnosis of posterior nasal obstruction. METHODS: Over one year period, from March 2002 to March 2003, we evaluated 130 adult patients that attended the Ear, Nose and Throat Department of Sohag University Hospital in Egypt with persistent nasal obstruction via anterior rhinoscopy and flexible nasopharyngoscopy. We reported the cause and site of obstruction in relation to the choanae. We confirmed the diagnosis by CT scanning, rigid endoscopic examination under general anesthesia, and histopathological analysis of biopsies taken. RESULTS: Forty-six percent of our cases had posterior nasal obstruction, 43.5% due to post-choanal lesions (mainly adenoid), 33% due to pre-choanal lesions (mainly choanal polyps), and 23.5% due to choanal lesions (mainly choanal adenoid). CONCLUSION: We conclude that flexible nasal endoscopy is superior to visual examination in the evaluation of nasal obstruction; hence, we recommend its routine use.
Adolescent↗
KTP laser inferior turbinoplasty: an alternative procedure to treat the nasal obstruction.
OBJECTIVE: Nasal obstruction resulting from inferior turbinate hypertrophy (ITH) was treated with KTP laser inferior turbinoplasty (KIT). The effectiveness of the procedure was assessed. METHODS: A prospective clinical trial was carried out in King Chulalongkorn Memorial Hospital from October 1, 1998 to September 30, 2000. Forty-eight patients with chronic nasal obstruction underwent KIT. Nasal obstruction was pre- and postoperatively assessed, based on 4-point scale, by the patient and investigator. The scores were compared by paired t-test. The correlation of assessment by the patient and investigator was also demonstrated by weighted kappa test. Pre- and postoperative rhinomanometric evaluations were performed in 29 patients and were compared with paired t-test. RESULTS: Significant reduction of nasal obstruction was obtained from assessment by the patient (P<0.000) and by the investigator (P<0.000). The symptoms of sneezing, itching and rhinorrhea were significantly reduced postoperatively (P<0.000). The cure and improvement rate of nasal obstruction were at 70.8 and 100% (assessed by the patient) and at 77.1 and 100% (assessed by the investigator) respectively, and they showed a moderate correlation (Kw=0.65). Rhinomanometrically, the total airway resistance decreased but of not statistic significance (P=0.219), however, the inspired nasal airflow at 150 Pa and the volume of nasal cavities were significantly increased (P<0.00 and P<0.001, respectively). CONCLUSION: KIP was shown to effectively reduce the symptom and sign of nasal obstruction as well as other nasal symptoms without any significant complications. It should be an alternative method in treating the patients with nasal obstruction resulting from hyperplastic inferior turbinate.
Adolescent↗
Aerophagia induced by the nasal obstruction on experimental animals.
The excessive accumulation of gas in the gastrointestinal tracts was invariably induced on experimental animals (mice, rats, guinea pigs, hamsters and rabbits) by simply obstructing nasal passages. The analysis of the gas showed the almost identical composition to the ambient air or flutus which was largely due to swallowed air. Also the numerous small foams were found on and underneath the epithelial lining of small intestine. The pathological evaluation was done both macroscopically and microscopically. Dying animals after nasal obstruction showed hemorrhagic and necrotic changes in the jejunum and ileum. This observation may cast some light to the pathogenesis of necrotizing enterocolitis in human neonatal.
Aerophagy↗
[Obstructive sleep apnea and obstructing nasal polyps].
BACKGROUND: Nasal obstruction may be a causative factor in the etiology of obstructive sleep apnea. No studies were found that dealt with the role of nasal polyps in sleep apnea. METHOD: Two male patients, 69 and 44 years old, were examined in our clinic because of nasal polyps occluding the nasal cavity. Their main complaint was nasal breathing obstruction with hyposmia. The clinical history revealed snoring but neither apnea nor daytime sleepiness was reported. Both patients underwent full nocturnal 12-channel polysomnography (PSG) prior to endonasal sinus surgery. PSG and nasal endoscopy were performed 3 months postoperatively. RESULT: The patients showed an increased apnea hypopnea index (AHI) from 21.1 to 76.6 and 7 to 38.8 respectively. Excessive daytime sleepiness (EDS) appeared and relative duration of REM sleep decreased. Nasal CPAP therapy was recommended. CONCLUSION: Although patients felt relieved after surgery since their nasal breathing problem was solved, the results with respect to AHI, EDS, and sleep pattern were unexpected. Perhaps these findings can be explained by surgical alteration of nasal receptors or by a postoperative switch from oral to nasal nocturnal breathing.
Adult↗
Pneumatization of the concha inferior as a cause of nasal obstruction.
Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.
Adult↗
Intranasal mucocele of the nasolacrimal duct: an important cause of neonatal nasal obstruction.
Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children's hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.
Female↗
Assessment of early- and late-phase nasal obstruction in atopic patients after nasal allergen challenge.
In order to study the types of nasal obstruction in allergic rhinitis, nasal allergen challenge was performed in 18 atopic patients, compared with a control group consisting of 10 healthy volunteers. Passive anterior rhinomanometry was used as an objective evaluation of nasal airway resistance. A 100% increase of nasal airway resistance was considered to be a positive reaction. In the control group, no obvious nasal obstruction was recorded after nasal phosphate buffered saline challenge. In the patient group, nasal obstruction occurred only after challenge in 94% during the early phase and in 82% during the late phase. During the late-phase four major types of nasal obstruction were found, i.e. no nasal obstruction; one-sided nasal obstruction only; bilateral nasal obstruction; and alternating nasal obstruction. Of the four types, the alternating type was the most common (47%) type, especially during the late-phase.
Adolescent↗
Nasal obstruction caused by cystic nasal conchae in cattle.
Four Holstein heifers were found to have partial nasal obstruction caused by bilateral cystic conchae. Three of the heifers (age range, 4 to 6 months) had a history of progressive nasal obstruction since near birth, were affected severely, and required surgical management. Each of 2 surgical procedures, a bilateral dorsolateral nasal flap approach and a dorsal nasal flap approach, was used successfully. The fourth heifer, which was 15 months old, had signs of nasal obstruction since shortly after birth, but was affected only mildly and was not treated. Follow-up information obtained 10 to 37 months later revealed that all cattle were considered normal and had no signs of nasal obstruction. In each case, a developmental problem or malformation of the ventral nasal concha resulting in cystic enlargement was suspected. The onset of clinical signs early in life and the bilateral nature suggested that the defect was of congenital origin.
Airway Obstruction↗