By- Dr. Supreet Singh Nayyar, AFMC

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Complaint of a blocked nose Complex clinical problem Frequently difficult to assess The perception of nasal airflow - subjective Efforts to improve our ability to ‘objectively’

measure nasal patency Gold standard would be a quantifiable,

reproducible, objective test with a strong correlation to the subjective perception of nasal airflow

Various methods2www.nayyarENT.com

Rhinomanometry provides a functional measure of the nasal airway resistance or conductance

Acoustic rhinometry provides an anatomical measurement of cross-sectional area or nasal volume

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Dynamic test of nasal function that calculates nasal airway resistance (NAR)

Measures Transnasal pressure Nasal airflow

Flow-pressure curves Laminar airflow versus turbulent airflow Three methods

Active anterior rhinomanometry Passive anterior rhinomanometry Active posterior rhinomanometry

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UNILATERAL NASAL AIRFLOW Measured at sample pressure point of 150 Pa and bilateral nasal airflow measured at 75 Pa are recommended as universal standards

However, Asian population cannot always achieve these pressures during normal quiet breathing and the lower sample pressures of 100 and 50 Pa, respectively, are generally accepted for nasal resistance measurements in Japan.

Total nasal resistance to airflow can be either determined directly using the posterior method of rhino manometry or it can be calculated by combining the two separate values of nasal resistance for the two nasal passages as shown in the formula below:

1/R (total) = 1/r (left) + 1/r (right) The reciprocal of total resistance is equal to the sum

of the reciprocals of left and right resistance.

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Based on the analysis of sound waves reflected from the nasal cavity

Two -dimensional picture of the nasal cavity Can identify the narrowest part of the nasal

cavity or minimal cross-sectional area (MCA) Usually corresponds to the nasal valve area

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Peak nasal inspiratory flow rate Body plethysmograhy Nasalance

Measured by pair of directional microphones mounted on either side of hard palate

Ratio of nasality of sound output from nose vs mouth Inversely proportional to nasal airway resistance Normal 40%

Rhinostereometry Plotting of changes of inf turbinate by binocular

microscope Patient head fixed by biting into tailor made tooth splint

fixed on microscope

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Symptoms over past one month

Nasal

Congestion

Nasal

Blockage

Breathing Difficulty

Trouble sleeping

Unable to get air during exercise

Not a

problem

Very mild problem

Mod problem

Fairly bad problem

Severe problem

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Nasal Obstruction Symptom Evaluation Scale

*Nose Scale 2003 The American Academy of Otolaryngology and Head & Neck Foundation. www.nayyarENT.com

Another subjective SNOT 22 (Sino Nasal Outcome Test)

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Vasoconstrictors

Drugs

Surgery

Nasal Cycle

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Nasal challenge test This test provides precise measurements of

changes in nasal airway resistance along with observations such as number of sneezes and measurement of inflammatory mediators in the nasal secretions after exposure to an allergen. The more commonly known "sniff test," uses a visual assessment of mucosal swelling and rhinorrhea after a small amount of dry pollen is inhaled.

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