Facial Plast Surg 2024; 40(03): 341-344
DOI: 10.1055/s-0044-1779483
Original Article

Algorithm for Nasal Breathing Impairment Evaluation

1   Department of Otorhinolaryngology, Hospital Luz Arrabida, Porto, Portugal
› Author Affiliations

Abstract

Assessing patients with complaints of nasal obstruction has traditionally been done by evaluation of the nasal airway looking for fixed or dynamic obstructive locations that could impair nasal airflow. Not infrequently, however, symptoms of nasal obstruction do not match the clinical examination of the nasal airway. Addressing this subset of patients may be a challenge to the surgeon. Evaluation of patients with symptoms of nasal obstruction should include a combination of a patient-reported assessment of nasal breathing and at least one objective method for measuring nasal airflow or nasal airway resistance or dimensions. This will allow distinction between patients with symptoms of nasal obstruction and low airflow or high nasal airway resistance and patients with similar symptoms but whose objective evaluation demonstrates normal nasal airflow or normal airway dimensions or resistance. Patients with low nasal airflow or high nasal airway resistance will require treatment to increase nasal airflow as a necessary step to improve symptoms, whereas patients with normal nasal airflow or nasal airway resistance will require a multidimensional assessment looking for less obvious causes of impaired nasal breathing sensation.



Publication History

Article published online:
01 February 2024

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  • References

  • 1 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 (06) 454-458
  • 2 Kjaergaard T, Cvancarova M, Steinsvåg SK. Relation of nasal air flow to nasal cavity dimensions. Arch Otolaryngol Head Neck Surg 2009; 135 (06) 565-570
  • 3 Xavier R, Azeredo-Lopes S, Menger DJ, de Carvalho HC, Spratley J. Objective measurement and patient-reported evaluation of the nasal airway: is correlation dependent on symptoms or on nasal airflow?. Clin Otolaryngol 2021; 46 (04) 744-751
  • 4 Jones AS, Wight RG, Durham LH. The distribution of thermoreceptors within the nasal cavity. Clin Otolaryngol Allied Sci 1989; 14 (03) 235-239
  • 5 Scheibe M, Schmidt A, Hummel T. Investigation of the topographical differences in somatosensory sensitivity of the human nasal mucosa. Rhinology 2012; 50 (03) 290-293
  • 6 Eccles R, Jones AS. The effect of menthol on nasal resistance to air flow. J Laryngol Otol 1983; 97 (08) 705-709
  • 7 Tsubone H. Nasal “flow” receptors of the rat. Respir Physiol 1989; 75 (01) 51-64
  • 8 Willatt DJ, Jones AS. The role of the temperature of the nasal lining in the sensation of nasal patency. Clin Otolaryngol Allied Sci 1996; 21 (06) 519-523
  • 9 Liu SC, Lu HH, Fan HC. et al. The identification of the TRPM8 channel on primary culture of human nasal epithelial cells and its response to cooling. Medicine (Baltimore) 2017; 96 (31) e7640
  • 10 Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: a literature review. Int Forum Allergy Rhinol 2014; 4 (10) 834-838
  • 11 Bailey RS, Casey KP, Pawar SS, Garcia GJ. Correlation of nasal mucosal temperature with subjective nasal patency in healthy individuals. JAMA Facial Plast Surg 2017; 19 (01) 46-52
  • 12 Sullivan CD, Garcia GJ, Frank-Ito DO, Kimbell JS, Rhee JS. Perception of better nasal patency correlates with increased mucosal cooling after surgery for nasal obstruction. Otolaryngol Head Neck Surg 2014; 150 (01) 139-147
  • 13 Moore GF, Freeman TJ, Ogren FP, Yonkers AJ. Extended follow-up of total inferior turbinate resection for relief of chronic nasal obstruction. Laryngoscope 1985; 95 (9, Pt 1): 1095-1099
  • 14 Shen J, Hur K, Li C, Zhao K, Leopold DA, Wrobel BB. Determinants and evaluation of nasal airflow perception. Facial Plast Surg 2017; 33 (04) 372-377
  • 15 Shusterman D. Trigeminal function in sino-nasal health and disease. Biomedicines 2023; 11 (07) 1778
  • 16 Migneault-Bouchard C, Boselie FJM, Hugentobler M, Landis BN, Frasnelli J. Trigeminal impairment in treatment-refractory chronic nasal obstruction. Rhinology 2021; 59 (03) 312-318
  • 17 Ulusoy S, Bayar Muluk N, Scadding GK. et al. The intranasal trigeminal system: roles in rhinitis (allergic and non-allergic). Eur Rev Med Pharmacol Sci 2022; 26 (2, Suppl): 25-37
  • 18 Zhao K, Jiang J. What is normal nasal airflow? A computational study of 22 healthy adults. Int Forum Allergy Rhinol 2014; 4 (06) 435-446
  • 19 Borojeni AAT, Garcia GJM, Moghaddam MG. et al. Normative ranges of nasal airflow variables in healthy adults. Int J CARS 2020; 15 (01) 87-98
  • 20 Casey KP, Borojeni AA, Koenig LJ, Rhee JS, Garcia GJ. Correlation between subjective nasal patency and intranasal airflow distribution. Otolaryngol Head Neck Surg 2017; 156 (04) 741-750
  • 21 Xavier R, Azeredo-Lopes S, Menger DJ, Cyrne de Carvalho H, Spratley J. Which nasal airway dimensions correlate with nasal airflow and with nasal breathing sensation?. Facial Plast Surg Aesthet Med 2021; (e-pub ahead of print) DOI: 10.1089/fpsam.2021.0148.
  • 22 Weitzman RE, Feng AL, Justicz N, Gadkaree SK, Lindsay RW. Unilateral nasal obstruction causes symptom severity scores similar to bilateral nasal obstruction. Facial Plast Surg 2020; 36 (04) 487-492
  • 23 Kaura A, Pendolino AL, Navaratnam A, Andrews PJ, Leung TS. The nasal obstruction balance index: a novel approach to improving correlation between unilateral nasal airway measurements and evaluating nasal airway asymmetry. Laryngoscope 2021; 131 (12) E2833-E2840
  • 24 Wang Y, Liu Y, Sun X. et al. Numerical analysis of respiratory flow patterns within human upper airway. Acta Mech Sin-PRC 2009; 25: 737-746
  • 25 Tan J, Han D, Wang J. et al. Numerical simulation of normal nasal cavity airflow in Chinese adult: a computational flow dynamics model. Eur Arch Otorhinolaryngol 2012; 269 (03) 881-889
  • 26 Chen XB, Lee HP, Chong VF, Wang Y. Assessment of septal deviation effects on nasal air flow: a computational fluid dynamics model. Laryngoscope 2009; 119 (09) 1730-1736
  • 27 Chen XB, Leong SC, Lee HP, Chong VF, Wang DY. Aerodynamic effects of inferior turbinate surgery on nasal airflow: a computational fluid dynamics model. Rhinology 2010; 48 (04) 394-400
  • 28 Kim SK, Heo GE, Seo A, Na Y, Chung SK. Correlation between nasal airflow characteristics and clinical relevance of nasal septal deviation to nasal airway obstruction. Respir Physiol Neurobiol 2014; 192: 95-101
  • 29 Brüning JJ, Goubergrits L, Heppt W, Zachow S, Hildebrandt T. Numerical analysis of nasal breathing: a pilot study. Facial Plast Surg 2017; 33 (04) 388-395
  • 30 Zhao K, Jiang J, Blacker K. et al. Regional peak mucosal cooling predicts the perception of nasal patency. Laryngoscope 2014; 124 (03) 589-595
  • 31 Kimbell JS, Frank DO, Laud P, Garcia GJ, Rhee JS. Changes in nasal airflow and heat transfer correlate with symptom improvement after surgery for nasal obstruction. J Biomech 2013; 46 (15) 2634-2643
  • 32 Xavier R, Menger DJ, de Carvalho HC, Spratley J. An overview of computational fluid dynamics preoperative analysis of the nasal airway. Facial Plast Surg 2021; 37 (03) 306-316