Peak nasal inspiratory flowmeter in evaluation of nasal obstruction

Year 2010, Volume: 20 Issue: 3, 154 - 160, 30.06.2010

M. Mustafa Gürdal Orhan Özturan

Abstract

Nasal obstruction is one of the major reasons for patients with nasal pathology to visit physicians. Since nasal obstruction is a subjective complaint, objective methods may be used for diagnosis in addition to the history and physical examination. At present, acoustic rhinometry and rhinomanometry are the frequently preferred objective diagnostic modality. So far, no single diagnostic method is sufficient by itself for the evaluation of nasal obstruction. Peak nasal inspiratory flowmetry is a physiologic method for the measurement of peak flow in response to deep nasal inspiration. It is very economic, portable and easy to measure compared to other objective methods, and is getting routinely used more and more in European countries. Although its effectivity and wide usage are supported by a number of studies in the literature, it has not been used sufficiently in our country.

Keywords

Nasal obstruction, peak flowmeter, peak nasal inspiratory flow

Nazal tıkanıklığın değerlendirilmesinde tepe nazal inspiratuvar akımmetre

Abstract

Burun tıkanıklığı, nazal patolojisi bulunan hastala- rın en sık doktora başvurma nedenleri arasındadır. Burun tıkanıklığı subjektif bir yakınma olması nede- niyle tanı koyma ve tedavi sonuçlarını değerlendirme aşamasında en doğru sonuca ulaşılabilmesi için öykü ve klinik muayene ile birlikte objektif yöntem- lerden de yararlanılmalıdır. Günümüzde akustik rino- metri ve rinomanometri sıklıkla başvurulan objektif yöntemlerdir. Ancak şu ana kadar geliştirilen tanı yöntemlerinden hiçbiri nazal tıkanıklığı değerlen- dirmede tek başına yeterli olamamıştır. Tepe nazal inspiratuvar akımmetre, derin nazal inspirasyonla oluşan tepe akımını ölçen fizyolojik bir yöntemdir. Diğer objektif tanı yöntemlerine kıyasla oldukça eko- nomik, taşınabilir ve kolay ölçüm yapılabilmesi nede- niyle Avrupa ülkelerinde rutin klinik kullanımı giderek yaygınlaşmaktadır. Etkinliği ve yaygın kullanım alanı, yapılmış birçok çalışma ile kanıtlanmış olmasına kar- şın ülkemizde yeteri kadar kullanılmamaktadır

Keywords

Burun tıkanıklığı, tepe akımmetre, nazal inspiratuvar tepe akım

References

• Settipane RA. Complications of allergic rhinitis. Allergy Asthma Proc 1999;20:209-13.
• Meltzer EO, Gallet CL, Jalowayski AA, Garcia J, Diener P, Liao Y, et al. Triamcinolone acetonide and flutica- sone propionate aqueous nasal sprays significantly improve nasal airflow in patients with seasonal aller- gic rhinitis. Allergy Asthma Proc 2004;25:53-8.
• Corey JP, Houser SM, Ng BA. Nasal congestion: a review of its etiology, evaluation, and treatment. Ear Nose Throat J 2000;79:690-3.
• Panagou P, Loukides S, Tsipra S, Syrigou K, Anastasakis C, Kalogeropoulos N. Evaluation of nasal patency: comparison of patient and clinician assessments with rhinomanometry. Acta Otolaryngol 1998;118:847-51.
• Corey JP. Acoustic rhinometry: should we be using it? Curr Opin Otolaryngol Head Neck Surg 2006;14:29-34.
• Hanif J, Eccles R, Jawad SS. Use of a portable spirom- eter for studies on the nasal cycle. Am J Rhinol 2001; 15:303-6.
• Hilberg O, Jackson AC, Swift DL, Pedersen OF. Evaluation of nasal cavity geometry by acoustic reflec- tion. J Appl Physiol 1989;66:295-303.
• Corey JP, Gungor A, Nelson R, Fredberg J, Lai V. A comparison of the nasal cross-sectional areas and volumes obtained with acoustic rhinometry and mag- netic resonance imaging. Otolaryngol Head Neck Surg 1997;117:349-54.
• Wang DY, Raza MT, Goh DY, Lee BW, Chan YH. Acoustic rhinometry in nasal allergen challenge study: which dimensional measures are meaningful? Clin Exp Allergy 2004;34:1093-8.
• Hilberg O, Pedersen OF. Acoustic rhinometry: influence of paranasal sinuses. J Appl Physiol 1996;80:1589-94.
• Cakmak O, Tarhan E, Coskun M, Cankurtaran M, Celik H. Acoustic rhinometry: accuracy and ability to detect changes in passage area at different locations in the nasal cavity. Ann Otol Rhinol Laryngol 2005;114:949- 57.
• Hilberg O, Jensen FT, Pedersen OF. Nasal airway geometry: comparison between acoustic reflections and magnetic resonance scanning. J Appl Physiol
• Gilain L, Coste A, Ricolfi F, Dahan E, Marliac D, Peynegre R, et al. Nasal cavity geometry measured by acoustic rhinometry and computed tomography. Arch Otolaryngol Head Neck Surg 1997;123:401-5.
• Nathan RA, Eccles R, Howarth PH, Steinsvåg SK, Togias A. Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2005;115(3 Suppl 1):S442-59.
• Hilberg O, Grymer LF, Pedersen OF. Spontaneous variations in congestion of the nasal mucosa. Ann Allergy Asthma Immunol 1995;74:516-21.
• Zheng C, Pochon N, Lacroix JS. Acoustic rhinometry: comparison of pre- and post-septoplasty. Zhonghua Er Bi Yan Hou Ke Za Zhi. 1995;30(6):343-6. [Abstract]
• Roithmann R, Cole P, Chapnik J, Barreto SM, Szalai JP, Zamel N. Acoustic rhinometry, rhinomanometry, and the sensation of nasal patency: a correlative study. J Otolaryngol 1994;23:454-8.
• Kim CS, Moon BK, Jung DH, Min YG. Correlation between nasal obstruction symptoms and objective parameters of acoustic rhinometry and rhinomanom- etry. Auris Nasus Larynx 1998;25:45-8.
• Eccles R, Reilly M, Eccles KS. Changes in the amplitude of the nasal cycle associated with symptoms of acute upper respiratory tract infection. Acta Otolaryngol 1996;116:77-81.
• Flanagan P, Eccles R. Spontaneous changes of uni- lateral nasal airflow in man. A re-examination of the ‘nasal cycle’. Acta Otolaryngol 1997;117:590-5.
• Broms P. Rhinomanometry. III. Procedures and criteria for distinction between skeletal stenosis and mucosal swelling. Acta Otolaryngol 1982;94:361-70.
• Rundcrantz H. Posture and congestion of nasal muco- sa in allergic rhinitis. Objective measure of effect of specific treatment. Acta Otolaryngol 1964;58:283-7.
• Cole P, Forsyth R, Haight JS. Effects of cold air and exercise on nasal patency. Ann Otol Rhinol Laryngol 1983;92:196-8.
• Eccles R, Tolley NS. The effect of alcohol ingestion upon nasal airway resistance. Rhinology 1987;25:245-8.
• Youlten LJ. The peak nasal inspiratory flow meter: a new instrument for the assessment of the response to immunotherapy in seasonal allergic rhinitis. Allergol immunopathol 1980;8:344.
• Holmström M, Scadding GK, Lund VJ, Darby YC. Assessment of nasal obstruction. A comparison between rhinomanometry and nasal inspiratory peak flow. Rhinology 1990;28:191-6.
• Phagoo SB, Watson RA, Pride NB. Use of nasal peak flow to assess nasal patency. Allergy 1997;52:901-8.
• Bermüller C, Kirsche H, Rettinger G, Riechelmann H. Diagnostic accuracy of peak nasal inspiratory flow and rhinomanometry in functional rhinosurgery. Laryngoscope 2008;118:605-10.
• Jones AS, Viani L, Phillips D, Charters P. The objective assessment of nasal patency. Clin Otolaryngol Allied Sci 1991;16:206-11.
• Clarke RW, Jones AS, Richardson H. Peak nasal inspiratory flow-the plateau effect. J Laryngol Otol 1995;109:399-402.
• Holmström M, Scadding GK, Lund VJ, Darby YC. Assessment of nasal obstruction. A comparison between rhinomanometry and nasal inspiratory peak flow. Rhinology 1990;28:191-6.
• Hellgren J, Jarlstedt J, Dimberg L, Torén K, Karlsson G. A study of some current methods for assessment of nasal histamine reactivity. Clin Otolaryngol Allied Sci 1997;22:536-41.
• Wilson AM, Sims EJ, Robb F, Cockburn W, Lipworth BJ. Peak inspiratory flow rate is more sensitive than acoustic rhinometry or rhinomanometry in detecting corticosteroid response with nasal histamine chal- lenge. Rhinology 2003;41:16-20.
• Hardcastle PF, White A, Prescott RJ. Clinical and rhinometric assessment of the nasal airway-do they measure the same entity? Clin Otolaryngol Allied Sci 1988;13:185-91.
• Hardcastle PF, White A, Prescott RJ. Clinical or rhino- metric assessment of the nasal airway-which is better? Clin Otolaryngol Allied Sci 1988;13:381-5.
• Gleeson MJ, Youlten LJ, Shelton DM, Siodlak MZ, Eiser NM, Wengraf CL. Assessment of nasal airway pat- ency: a comparison of four methods. Clin Otolaryngol Allied Sci 1986;11:99-107.
• Fairley JW, Durham LH, Ell SR. Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate. Clin Otolaryngol Allied Sci 1993;18:19-22.
• Wilson AM, Orr LC, Sims EJ, Lipworth BJ. Effects of monotherapy with intra-nasal corticosteroid or com- bined oral histamine and leukotriene receptor antago- nists in seasonal allergic rhinitis. Clin Exp Allergy 2001;31:61-8.
• Day JH, Briscoe MP, Rafeiro E, Ellis AK, Pettersson E, Akerlund A. Onset of action of intranasal budes- onide (Rhinocort aqua) in seasonal allergic rhinitis studied in a controlled exposure model. J Allergy Clin Immunol 2000;105:489-94.
• Keith P, Nieminen J, Hollingworth K, Dolovich J. Efficacy and tolerability of fluticasone propionate nasal drops 400 microgram once daily compared with placebo for the treatment of bilateral polyposis in adults. Clin Exp Allergy 2000;30:1460-8.
• Ruhno J, Andersson B, Denburg J, Anderson M, Hitch D, Lapp P, et al. A double-blind comparison of intra- nasal budesonide with placebo for nasal polyposis. J Allergy Clin Immunol 1990;86:946-53.
• Lund VJ, Flood J, Sykes AP, Richards DH. Effect of flu- ticasone in severe polyposis. Arch Otolaryngol Head Neck Surg 1998;124:513-8.
• Penttilä M, Poulsen P, Hollingworth K, Holmström M. Dose-related efficacy and tolerability of fluticasone propionate nasal drops 400 microg once daily and twice daily in the treatment of bilateral nasal polypo- sis: a placebo-controlled randomized study in adult patients. Clin Exp Allergy 2000;30:94-102.
• Sandhu AS, Temple RH, Timms MS. Partial laser tur- binectomy: two year outcomes in patients with allergic and non-allergic rhinitis. Rhinology 2004;42:81-4.
• Marais J, Murray JA, Marshall I, Douglas N, Martin S. Minimal cross-sectional areas, nasal peak flow and patients’ satisfaction in septoplasty and inferior tur- binectomy. Rhinology 1994;32:145-7.
• Lund VJ, Scadding GK. Objective assessment of endoscopic sinus surgery in the management of chronic rhinosinusitis: an update. J Laryngol Otol
• Malm L, Gerth van Wijk R, Bachert C. Guidelines for nasal provocations with aspects on nasal pat- ency, airflow, and airflow resistance. International Committee on Objective Assessment of the Nasal Airways, International Rhinologic Society. Rhinology 2000;38:1-6.
• Hellgren J, Jarlstedt J, Dimberg L, Torén K, Karlsson G. A study of some current methods for assessment of nasal histamine reactivity. Clin Otolaryngol Allied Sci 1997;22:536-41.