Nasal congestion index: A measure for nasal obstruction.
ABSTRACT The relationship between congestion of the nasal mucosa and subjective nasal obstruction remains poorly defined. Applying the novel Nasal Congestion Index (NCI), we compared subjective nasal obstruction with objective measures for reversible congestion of the nasal mucosa.
A total of 2,523 consecutive patients were included in this cross-sectional study. Eligible subjects were adults referred to the ENT department, Sørlandet Hospital, Kristiansand, Norway, for evaluation of chronic nasal or sleep-related complaints.
Subjects underwent acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) at baseline and after decongestion of the nasal mucosa. Based on these registrations, an NCI was calculated for minimal cross-sectional area (MCA), nasal cavity volume (NCV), and PNIF, and employed for quantification of reversible mucosal congestion. Subjective nasal obstruction was measured by nasal obstruction visual analogue scales (NO-VAS). Statistical analyses were based on ANOVA and multiple linear and logistic regression, adjusting for age, gender, body mass index, asthma, allergy, smoking history, and type of planned intervention.
Crude estimates indicated that the NCIs were significantly higher in subjects with severe complaints of nasal obstruction compared with subjects with lesser symptoms (P < .001). These associations were confirmed by linear and logistic regression analyses. NCI for MCA, NCV, and PNIF showed highly significant associations with subjective nasal obstruction (P < .001).
We have clearly demonstrated an association between subjective nasal obstruction and reversible congestion of the nasal mucosa by employing the NCI. The measure has proven to be useful for evaluating patients with complaints of nasal obstruction.
Article: Platelet-activating factor nasal challenge induces nasal congestion and reduces nasal volume in both healthy volunteers and allergic rhinitis patients.[show abstract] [hide abstract]
ABSTRACT: Platelet-activating factor (PAF) is a lipid mediator produced by most inflammatory cells. Clinical and experimental findings suggest that PAF participates in allergic rhinitis (AR) pathogenesis. The aim was to assess the PAF ability to induce clinical response in nasal airway after local stimulation. Ten nonatopic healthy volunteers (HVs) and 10 AR patients out of pollen season were enrolled. PAF increasing concentrations (100, 200, and 400 nM) were instilled into both nasal cavities (0, 30, and 60 minutes, respectively). Nasal symptoms (congestion, rhinorrhea, sneezing, itching, and total 4 symptom score and nasal volume between the 2nd and 5th cm (Vol2-5) using acoustic rhinometry (AcR), were assessed at -30, 0, 30, 60, 90, 120, and 240 minutes. PAF increased individual and total nasal symptom score in both HVs and seasonal AR (SAR) patients from 30 to 120 minutes (maximum score at 120', p < 0.05). Nasal obstruction was the most relevant and lasting nasal symptom. PAF also induced a significant reduction of Vol2-5 at 90' (27%), 120' (38.7%), and 240' (36.4%). No differences in the response to PAF nasal challenge were observed between HVs and SAR subjects in either clinical symptoms or AcR. This is the first description of PAF effects on human nasal mucosa using a cumulative dose schedule and evaluated by both nasal symptoms and AcR. Nasal provocation with PAF showed long-lasting effects on nasal symptoms and nasal obstruction in HVs and in patients with SAR. Nasal challenge may be a useful tool to investigate the role of PAF in AR and the potential role of anti-PAF drugs.American Journal of Rhinology and Allergy 03/2013; 27(2):48-52.
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ABSTRACT: How well do subjective descriptions of the sensation of nasal closure or absence of nasal patency agree with objective measures of nasal geometry and airflow? Problems with this concept begin with terminology. "Congestion" has been applied to both the subjective and objective measures. Therefore, the term "fullness" will be used to describe perceptions of nasal mucosal heaviness or blockage that subjects with allergic rhinitis articulate. "Congestion" will refer to the objective measures used to assess patency. Sensations attributed to the nasal mucosa are highly integrated interpretations summed from multiple subsets of nociceptive and other neurons. Activation of sensor systems is required to depolarize afferent neurons. These sensors and other receptor proteins can be modulated by inflammation as part of the neural plasticity that leads to increased sensitivity to nasal stimuli. This plasticity and hyperalgesia may extend from the afferent neuron to spinal cord dorsal horn synapses, and regulatory and analytical regions of the brainstem and cerebrum. Although glandular hypersecretion can deliver obstructing material into the nasal cavities, the dilation of deep venous sinusoids is the strongest factor regulating nasal airspace volumes. There is a long history of attempts to correlate subjective sensations to objective measurements such as airflow resistance (rhinomanometry), nasal wall geometry (acoustic rhinometry), and peak nasal inspiratory flow. The medical evidence supporting each method has been analyzed on the basis of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. These results provide a starting point for linking the outcomes of pathophysiological processes with a patient's psychometrically calibrated sensation of airflow.Proceedings of the American Thoracic Society 03/2011; 8(1):62-9.