Assessment of nasal airway patency during pregnancy and postpartum period: correlation between subjective and objective techniques

Yıl 2016, Cilt: 26 Sayı: 2, 92 - 100, 10.05.2016

Mehmet Karataş Osman Halit Çam Muhammet Tekin

Öz

Objectives: This study aims to determine the physiological changes in a pregnant woman’s nasal airway, the frequency of pregnancy rhinitis, and the correlation among anterior rhinoscopy AnR , anterior rhinomanometry ARM , and subjective nasal obstruction score as she progresses through pregnancy into the postpartum period PPP . Patients and Methods: Twenty non-smoking healthy pregnant women aged 19-35 average 27.5±4.7 without a history of either respiratory allergy or chronic nasal or sinus problems were included in the study. Detailed history taking, AnR, and ARM were performed by the same ear nose and throat specialist at each trimester and postpartum second week. From then on, the participants scored, subjectively, morning levels of nasal obstruction 0= none, 1= slight, 2= moderate, 3= severe, 4= total obstruction . Results: The AnR scores were low and the ARM findings were in normal range in the first trimester. Increasing AnR scores through pregnancy and decreasing AnR scores at PPP were statistically significant. Similarly, the ARM findings increased through pregnancy and decreased to normal levels at PPP; however, these changes among trimesters and PPP were not statistically significant. Conclusion: Anterior rhinomanometry and AnR are useful tools in the determination of nasal physiological changes as pregnancy progresses to PPP.

Anahtar Kelimeler

Anterior rhinoscopy, objective/subjective technique, pregnancy rhinitis, rhinomanometry

Gebelik sırasında ve postpartum dönemde nazal hava yolu açıklığının değerlendirilmesi

Öz

Amaç: Bu çalışmada gebeliği postpartum döneme PPD doğru ilerleyen bir kadının nazal hava yolundaki fizyolojik değişiklikler, gebelik rinitinin sıklığı ve anterior rinoskopi AnR , anterior rinomanometri ARM ve subjektif burun tıkanıklığı skoru arasındaki ilişki belirlendi.Hastalar ve Yöntemler: Yaşları 19-35 ortalama 27.5±4.7 olan, sigara içmeyen, respiratuvar alerjisi veya kronik nazal ya da sinüs problemleri olmayan 20 sağlıklı gebe kadın çalışmaya dahil edildi. Her trimesterde ve postpartum ikinci haftada aynı kulak burun ve boğaz uzmanı tarafından detaylı öykü alımı, AnR ve ARM uygulandı. Sonrasında, katılımcılar burun tıkanıklığının sabahki düzeylerini subjektif olarak puanladı 0= yok, 1= az, 2= orta, 3= şiddetli, 4= tam tıkalı .Bulgular: Birinci trimesterde AnR skorları düşük ve ARM bulguları normal aralıkta idi. Gebelik boyunca artan AnR skorları ve PPD’de azalan AnR skorları istatistiksel olarak anlamlıydı. Benzer şekilde, ARM bulguları gebelik boyunca arttı ve PPD’de normal düzeylere azaldı; ancak, trimesterler ve PPD arasındaki bu değişiklikler istatistiksel olarak anlamlı değildi.Sonuç: Gebelik PPD’ye doğru ilerledikçe nazal fizyolojik değişikliklerin belirlenmesinde ARM ve AnR faydalı araçlardır

Anahtar Kelimeler

Anterior rinoskopi, objektif/subjektif teknik, gebelik riniti, rinomanometri

Kaynakça

• Ellegård E, Karlsson G. Nasal congestion during pregnancy. Clin Otolaryngol Allied Sci 1999;24:307-11.
• Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE. Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med 2000;162:252-7.
• Mabry RL. Intranasal steroid injection during pregnancy. South Med J 1980;73:1176-9.
• Franklin KA, Holmgren PA, Jönsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000;117:137-41.
• Rundcrantz H. Postural variations of nasal patency. Acta Otolaryngol 1969;68:435-43.
• Bresgen M. Chronic rhinitis and pharyngitis. Vienna (Austria): Urban & Schwarzenberg; 1881 in Germany.
• Mac Kenzie JN. Irritation of the sexual apparatus as an etiological factor in the production of nasal disease. Am J Med Sci 1884;87:360-5.
• Mac Kenzie JN. The physiological and pathological relations between the nose and the sexual apparatus of man. Alienist and Neurologist 1898;19:219-39.
• Endriss G. Update on the physiological and pathological relationship between the upper airway and the sexual organs. Würzburg, Germany: 1892 in Germany.
• Mohun M. Incidence of vasomotor rhinitis during pregnancy. Arch Otolaryngol 1943;37:699-709.
• Ruskin SL. Rationale of estrogen therapy of primary atrophic rhinitis (ozena). Arch Otolaryngol 1942;36:632-49.
• Bernheimer LB, Soskin S. Mechanism of effect of estrogen on nasal mucosa in atrophic rhinitis. Arch Otolaryngol 1940;32:957-9.
• Hu FB, Willett WC, Colditz GA, Ascherio A, Speizer FE, Rosner B, et al. Prospective study of snoring and risk of hypertension in women. Am J Epidemiol 1999;150:806-16.
• Lundberg JO, Weitzberg E. Nasal nitric oxide in man. Thorax 1999;54:947-52.
• Hamano N, Terada N, Maesako K, Ikeda T, Fukuda S, Wakita J, et al. Expression of histamine receptors in nasal epithelial cells and endothelial cells--the effects of sex hormones. Int Arch Allergy Immunol 1998;115:220-7.
• Mortimer H, Wright RP, Collip JB. The Effect of the Administration of OEstrogenic Hormones on the Nasal Mucosa of the Monkey (Macaca Mulatta). Can Med Assoc 1936;35:503-13.
• Krasnow JS, Tollerud DJ, Naus G, DeLoia JA. Endometrial Th2 cytokine expression throughout the menstrual cycle and early pregnancy. Hum Reprod 1996;11:1747-54.
• Lahita RG. The effects of sex hormones on the immune system in pregnancy. Am J Reprod Immunol 1992;28:136-7.
• Mabry RL. The management of nasal obstruction during pregnancy. Ear Nose Throat J 1983;62:28-33.
• Bowser C, Riederer A. Detection of progesterone receptors in connective tissue cells of the lower nasal turbinates in women. Laryngorhinootologie 2001;80:182-6. [Abstract]
• Bende M, Hallgrade U, Sjögren C. Occurence of nasal congestion during pregnancy. Am J Rhinol 1989;3:217-9.
• Ellegård E, Oscarsson J, Bougoussa M, Igout A, Hennen G, Edén S, et al. Serum level of placental growth hormone is raised in pregnancy rhinitis. Arch Otolaryngol Head Neck Surg 1998;124:439-43.
• Mabry RL. Rhinitis of pregnancy. South Med J 1986;79:965-71.
• Reynolds S. & Foster F. Acetylcholine-equivalent content of the nasal mucosa in rabbits and cats, before and after administration of estrogen. Am J Physiol 1940;131:422-5.
• Toppozada H, Toppozada M, El-Ghazzawi I, Elwany S. The human respiratory nasal mucosa in females using contraceptive pills. An ultramicroscopic and histochemical study. J Laryngol Otol 1984;98:43-51.
• Philpott CM, Conboy P, Al-Azzawi F, Murty G. Nasal physiological changes during pregnancy. Clin Otolaryngol Allied Sci 2004;29:343-51.
• Robinson AM, Philpott CM, Gaskin JA, Wolstenholme CR, Murty GE. The effect of female hormone manipulation on nasal physiology. Am J Rhinol 2007;21:675-9.
• Derkay CS. Eustachian tube and nasal function during pregnancy: a prospective study. Otolaryngol Head Neck Surg 1988;99:558-66.
• Tüz M, Uygur K, Kaya H, Mandal T, Doğru H. Gebelerde nazal konjesyon. KBB Klinikleri 2000;2:80-2.
• Ellegård E, Karlsson G. IgE-mediated reactions and hyperreactivity in pregnancy rhinitis. Arch Otolaryngol Head Neck Surg 1999;125:1121-5.
• Löth S, Bende M. Effect of nasal anaesthesia on lacrimal function after nasal allergen challenge. Clin Exp Allergy 1994;24:375-6.
• Jones AS, Willatt DJ, Durham LM. Nasal airflow: resistance and sensation. J Laryngol Otol 1989;103:909-11.
• Gungor A, Moinuddin R, Nelson RH, Corey JP. Detection of the nasal cycle with acoustic rhinometry: techniques and applications. Otolaryngol Head Neck Surg 1999;120:238-47.
• Szücs E, Clement PA. Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patients with nasal septal deviation. Am J Rhinol 1998;12:345-52.
• Numminen J, Ahtinen M, Huhtala H, Rautiainen M. Comparison of rhinometric measurements methods in intranasal pathology. Rhinology 2003;41:65-8.
• Yepes-Nuñez JJ, Bartra J, Muñoz-Cano R, Sánchez- López J, Serrano C, Mullol J, et al. Assessment of nasal obstruction: correlation between subjective and objective techniques. Allergol Immunopathol (Madr) 2013;41:397-401.
• Rambur B. Pregnancy rhinitis and rhinitis medicamentosa. J Am Acad Nurse Pract 2002;14:527-30.
• Stroud RH, Wright ST, Calhoun KH. Nocturnal nasal congestion and nasal resistance. Laryngoscope 1999;109:1450-3.
• Sato K. Treatment of allergic rhinitis during pregnancy. Clinical & Experimental Allergy Reviews 2012;12:31-6.