phenylephrine-hydrochloride and Airway-Obstruction

To study the role of upper airway endoscopy (UAE) in craniofacial malformations in all different management approaches described in the literature.. A narrative review was performed, based on a search in pubmed.. UAE use was reviewed over five domains: 1) Diagnosis of glossoptosis and endoscopic classification: drug-induced sleep endoscopy is recommended to graduate tongue base obstruction; there is still no consensus on the graduation system to be used. 2) Airway abnormalities: there is a high incidence of additional lesions in conjunction with glossoptosis. 3) Swallowing evaluation: a formal comparison with fluoroscopy (gold standard) has not yet been performed in this population. 4) Intubation: thin bronchoscopes allow intubation of small babies; moreover, intubation with rigid video-assisted laryngoscopes show a high success rate in this population. 5) Treatment outcome monitoring: there is no consensus on the ideal parameters to be checked.. Some approaches have already been well established in the management of patients with craniofacial malformations, e.g. the endocopic evaluation of glossoptosis and associated lesions and its role as an intubation assistance tool, while others need to be subject of further research, e.g. its role in swallowing investigation and as a postoperative success control predictor.

Topics: Airway Obstruction; Endoscopy; Humans; Infant; Intubation, Intratracheal; Laryngoscopy; Nose; Pierre Robin Syndrome

Identification of the obstruction site in the upper airway may help in treatment selection for patients with sleep-disordered breathing. Because of limitations of existing techniques, there is a continuous search for more feasible methods. Snoring sound parameters were hypothesized to be potential predictors of the obstruction site. Therefore, this review aims to i) investigate the association between snoring sound parameters and the obstruction sites; and ii) analyze the methodology of reported prediction models of the obstruction sites.. The literature search was conducted in PubMed, Embase.com, CENTRAL, Web of Science, and Scopus in collaboration with a medical librarian. Studies were eligible if they investigated the associations between snoring sound parameters and the obstruction sites, and/or reported prediction models of the obstruction sites based on snoring sound.. Of the 1016 retrieved references, 28 eligible studies were included. It was found that the characteristic frequency components generated from lower-level obstructions of the upper airway were higher than those generated from upper-level obstructions. Prediction models were built mainly based on snoring sound parameters in frequency domain. The reported accuracies ranged from 60.4% to 92.2%.. Available evidence points toward associations between the snoring sound parameters in the frequency domain and the obstruction sites in the upper airway. It is promising to build a prediction model of the obstruction sites based on snoring sound parameters and participant characteristics, but so far snoring sound analysis does not seem to be a viable diagnostic modality for treatment selection.

Topics: Airway Obstruction; Humans; Nose; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring; Sound

It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.

Topics: Airway Obstruction; Humans; Nasopharynx; Nose; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography

Topics: Airway Obstruction; Endoscopy; Humans; Nose; Sleep; Sleep Apnea, Obstructive; Syndrome

Sleep disordered breathing (SDB) is a common condition and could be a risk factor for cardiovascular morbidity and mortality. However, the pathogenesis of SDB remains to be elucidated. In general, SDB is divided into two forms, obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from the sleep-related collapse of the upper airway (UA) in association with multiple factors like race, gender, obesity and UA dimensions. CSA primarily results from a fall in PaCO2 to a level below the apnea threshold during sleep through the reflex inhibition of central respiratory drive. It has been reported that UA alterations (i.e., collapse or dilation) can be observed in CSA. This review highlights the roles of the UA in the pathogenesis and pathophysiology of SDB.

Topics: Airway Obstruction; Cardiovascular Diseases; Female; Humans; Male; Nasal Obstruction; Nose; Obesity; Palatal Muscles; Pharyngeal Muscles; Pharynx; Respiratory Mechanics; Risk Factors; Sex Factors; Sleep; Sleep Apnea, Central; Sleep Apnea, Obstructive; Wakefulness

While several articles describe clinical management of foreign bodies injuries in the upper air tract, little epidemiological evidence is available from injury databases.. This article aims to understand the burden of airway FB injuries in high-, low-, and middle-income countries as emerging from scientific literature.. One thousand six hundred ninety-nine published articles 1978-2008.. A free text search on PubMed database ((foreign bodies) or (foreign body)) and ((aspiration) or (airways) or (tracheobronchial) or (nasal) or (inhalation) or (obstruction) or (choking) or (inhaled) or (aspirations) or (nose) or (throat) or (asphyxiation)) and ((children) or (child)).. Information on reported injuries according to country, time period, children sex and age, FB type, site of obstruction, symptoms, signs, diagnostic and therapeutic procedures, delay at the diagnosis, complications, number of deaths.. Serious complications occur both in high-income and low-middle income countries in a considerable proportion of cases (10% and 20%, respectively). Similarly, death is not infrequent (5-7% of cases).. Few countries have good systematic data collection and there's a lack of sensibility in parents and clinicians in terms of acknowledge of the choking risk. On the contrary, international surveillance systems able to collect information in a standardized way need to be implemented.

Topics: Airway Obstruction; Child; Developed Countries; Developing Countries; Foreign Bodies; Global Health; Humans; Larynx; Lung; Nose; Respiratory Aspiration; Risk Factors; Trachea

Imaging plays a role in the anatomic assessment of the airway and adjacent structures. This article discusses the use of 3-dimensional (3D) imaging (cone beam computed tomography [CBCT]) to evaluate the airway and selected regional anatomic variables that may contribute to obstructive sleep-disordered breathing (OSDB) in patients. CBCT technology uses a cone-shaped x-ray beam with a special image intensifier and a solid-state sensor or an amorphous silicon plate for capturing the image. Incorporation of 3D imaging into daily practice will allow practitioners to readily evaluate and screen patients for phenotypes associated with OSDB.

Topics: Airway Obstruction; Cone-Beam Computed Tomography; Epiglottis; Humans; Imaging, Three-Dimensional; Mandible; Maxillofacial Development; Nose; Palate, Soft; Pharynx; Sleep Apnea Syndromes; Temporomandibular Joint Disorders; Tongue

Over the last several decades, various surgical treatments have been advocated and used to treat obstructive sleep apnea. Treatments ranging from aggressive procedures, such as tracheostomy, to the least-invasive procedures, such as radioablation, have not yielded satisfactory results. One of the major causes for surgical failures and lower success rates lies in the inadequate understanding and appreciation of the anatomic and pathophysiologic factors that contribute to upper airway obstruction. In some cases, combinations of various surgical techniques may help improve the conditions. This article reviews several major types of surgical procedures, their complications, and the recommended approaches for retreatments.

Topics: Airway Obstruction; Catheter Ablation; Humans; Laser Therapy; Mandibular Advancement; Nose; Palate; Patient Care Planning; Patient Selection; Postoperative Complications; Prostheses and Implants; Reoperation; Risk Factors; Sleep Apnea, Obstructive; Surgical Flaps; Tracheostomy; Uvula

Upper airway disorders in children may be divided into those that are congenital in origin and those that are acquired. The presentation and management of these disorders is significantly influenced both by the anatomic location of the pathology, which is usually obstructive in nature, and by the severity of the obstruction. This discussion provides an overview of the presentation, diagnosis, management, and potential complications of the most commonly seen upper airway disorders. These disorders are presented within an anatomic framework, progressing from proximal at the nares to distal at the carina.

Topics: Airway Obstruction; Child; Choanal Atresia; Constriction, Pathologic; Hemangioma; Humans; Laryngeal Diseases; Larynx; Nose; Retrognathia; Trachea

Obstruction of the upper airway may cause arousals resulting in daytime sleepiness and cardiovascular disturbances. The upper airway resistance syndrome may easily be overlooked because conventional measurements of oronasal airflow and thoracic and abdominal efforts are not sensitive enough. By measuring esophageal pressure even small disturbances can be detected, but the esophageal gauge may disturb sleep. We conclude that other, less invasive methods like measurements of impedance by forced oscillation technique, or flattening of the inspiratory flow contour could be valid alternatives in the diagnosis of the upper airway resistance syndrome. Other methods, such as measurements of the pulse transit time, phase angle, or systolic blood pressure profile are promising, but need further evaluation.

Topics: Airway Obstruction; Airway Resistance; Arousal; Blood Pressure; Electric Impedance; Equipment Design; Esophagus; Hemodynamics; Humans; Inhalation; Mouth; Nose; Oscillometry; Pressure; Pulmonary Ventilation; Pulse; Sleep Apnea Syndromes; Sleep Stages; Syndrome

A rare case of a newborn suffering from arhinia with complete airway obstruction is reported. The complexity of the life-threatening airway obstruction is described and adequate treatment is reported. The relevant literature is reviewed, and the different approaches to treatment are discussed.

Topics: Abnormalities, Multiple; Airway Obstruction; Eye Abnormalities; Eyelids; Female; Humans; Infant, Newborn; Nasal Cavity; Nose; Radiography

Topics: Adult; Airway Obstruction; Female; Head and Neck Neoplasms; Humans; Nose; Paraganglioma; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

Topics: Airway Obstruction; Airway Resistance; Humans; Manometry; Nasopharynx; Nose; Pulmonary Ventilation; Work of Breathing

The controversy over whether altered development of orofacial structures arises purely from expression of genetic potential or is influenced by environmental factors is reviewed. Resolving this controversy will determine the need for early intervention to permit nasal respiration and for orthodontic treatment.

Topics: Airway Obstruction; Humans; Maxillofacial Development; Mouth Breathing; Nose; Nose Diseases; Respiration

Topics: Airway Obstruction; Humans; Nose

A subject with a septal perforation was studied rhinometrically to confirm that the congested choana did not limit airflow when the anterior nose was decongested. It did not. This suggests that in an undefined proportion of patients with swollen diseased mucosa, surgery to the anterior nose may be sufficient to relieve nasal obstruction.

Topics: Adrenergic alpha-Antagonists; Aged; Airway Obstruction; Airway Resistance; Histamine; Humans; Imidazoles; Male; Nasal Mucosa; Nasal Septum; Nasopharynx; Nose; Nose Diseases; Radiography

Both neural and anatomical factors play an important role in the maintenance of upper airway patency. An abnormality in one or both of these factors is felt to be the underlying cause of obstructive sleep apnea.

Topics: Airway Obstruction; Airway Resistance; Central Nervous System; Humans; Larynx; Mandible; Muscles; Nose; Oropharynx; Pharynx; Positive-Pressure Respiration; Pressure; Respiratory Physiological Phenomena; Respiratory System; Sleep; Sleep Apnea Syndromes; Snoring; Tomography, X-Ray Computed

Two types of Eustachian tube dysfunction can result in otitis media: obstruction and abnormal patency. Obstruction may be either functional or mechanical. Functional obstruction can result from persistent collapse of the Eustachian tube due to increased tubal compliance, an inadequate active opening mechanism, or both. Mechanical obstruction may be the result of either intrinsic or extrinsic factors. Otitis media can result from inadequate ventilation of the middle ear or entry of unwanted nasopharyngeal secretions into the middle ear (by aspiration, insufflation, or reflux), or both. An understanding of these concepts of Eustachian tube function and otitis media can then be related to the rationale for nonsurgical and surgical management and prevention of middle-ear disease.

Topics: Adult; Airway Obstruction; Child; Eustachian Tube; Humans; Infant; Nose; Otitis Media with Effusion; Pressure

Topics: Adenoids; Airway Obstruction; Dental Occlusion; Humans; Longitudinal Studies; Maxillofacial Development; Mouth Breathing; Nose; Physiology

Topics: Adult; Airway Obstruction; Airway Resistance; Child; Cold Temperature; Emotions; Hot Temperature; Humans; Humidity; Manometry; Nasal Mucosa; Nasal Provocation Tests; Nose; Nose Diseases; Permeability; Reference Values; Respiration; Vasomotor System

Topics: Airway Obstruction; Anesthetics, Local; Headache; Hearing Disorders; Histamine H1 Antagonists; Humans; Imidazoles; Mucus; Nasal Decongestants; Nose; Nose Diseases; Phenethylamines; Sneezing

Topics: Airway Obstruction; Airway Resistance; Gases; Humans; Hypersensitivity; Manometry; Methods; Nasal Mucosa; Nose; Nose Diseases; Plethysmography, Whole Body; Pressure; Rheology; Rhinitis, Allergic, Seasonal; Spirometry; Transducers

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.

Topics: Adult; Aged; Airway Obstruction; Carcinoma, Squamous Cell; Epistaxis; Female; Humans; Hypersensitivity; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Recurrence; Sex Factors; Terminology as Topic; Tomography, X-Ray; Virus Diseases

The objective of the study was to determine whether a naso-oesophageal probe modifies sleep and cardiorespiratory patterns in infants with repeated obstructive apnoeas. Two polygraphic recording sessions were conducted in random order for 2 nights on 35 infants suspected to have repeated obstructive sleep apnoeas. One sleep study was performed with a pH probe inserted through the nasal passage down to the distal portion of the oesophagus. The other session was conducted without any naso-oesophageal probe (the baseline study). For the 25 infants who presented repeated obstructive apnoeas during baseline studies, the presence of the probe was associated with a small, but significant, decrease in the number of central apnoeas (median frequency of 18.5 apnoeas per hour without a probe; 16.1 per hour with the probe; P=0.040), and obstructive apnoeas (median of 1.9 apnoeas per hour without a probe; 0.6 per hour with the probe; P=0.016). The presence of the probe was also associated with a small increase in percentage non-rapid eye movement (NREM) sleep frequency. The changes were statistically significant only for infants who had no obstructive apnoea during baseline studies (29 vs. 31%). The presence of a naso-oesophageal probe significantly modifies the infants' respiratory characteristics during sleep. These findings should be considered when reporting and interpreting sleep studies in infants.

Topics: Airway Obstruction; Electrocardiography; Electroencephalography; Electrooculography; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Nose; Periodicity; Polysomnography; Random Allocation; Retrospective Studies; Sleep Apnea, Obstructive; Sleep, REM

Surgical management of obstructive sleep apnea remains a surgical challenge. Multidisciplinary collaboration is a fundamental element. We report the principles of management as proposed to the patient and preliminary results obtained in a series of 26 patients treated in the phase I of the Stanford protocol. Cure rate after this phase was 50%. Different research projects in this area are discussed.

Topics: Adult; Aged; Airway Obstruction; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Nose; Palate, Soft; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

Anesthetic agents inhibit the respiratory activity of upper airway muscles more than the diaphragm, creating a potential for narrowing or complete closure of the pharyngeal airway during anesthesia. Because the underlying mechanisms leading to airway obstruction in sleep apnea and during anesthesia are similar, it was hypothesized that anesthesia-induced pharyngeal narrowing could be counteracted by applying nasal continuous positive airway pressure (CPAP).. Anesthesia was induced in ten healthy volunteers (aged 25-34 yr) by intravenous administration of propofol in 50-mg increments every 30-s to a maximum of 300 mg. Magnetic resonance images of the upper airway (slice thickness of 5 mm or less) were obtained in the awake state, during propofol anesthesia, and during administration of propofol plus 10 cm nasal CPAP.. Minimum anteroposterior diameter of the pharynx at the level of the soft palate decreased from 6.6 +/- 2.2 mm (SD) in the awake state to 2.7 +/- 1.5 mm (P < 0.05) during propofol anesthesia and increased to 8.43 +/- 2.5 mm (P < 0.05) after nasal CPAP application. Anteroposterior diameter of the pharynx at the level of the dorsum of the tongue increased from 7.9 +/- 3.5 mm during propofol anesthesia to 12.9 +/- 3.6 mm (P < 0.05) after nasal CPAP. Pharyngeal volume (from the tip of the epiglottis to the tip of the soft palate, assuming this space to be a truncated cone) significantly increased from 2,437 +/- 1,008 mm3 during propofol anesthesia to 5,847 +/- 2,827 mm3 (P < 0.05) after nasal CPAP application.. In contrast to the traditional view that relaxation of the tongue causes airway obstruction, this study suggests that airway closure occurs at the level of the soft palate. Application of nasal CPAP can counteract an anesthesia-induced pharyngeal narrowing by functioning as a pneumatic splint. This is supported by the observed reduction in anteroposterior diameter at the level of the soft palate during propofol anesthesia and the subsequent increase in this measurement during nasal CPAP application.

Topics: Adult; Airway Obstruction; Anesthetics, Intravenous; Female; Humans; Magnetic Resonance Imaging; Male; Nose; Palate, Soft; Pharynx; Positive-Pressure Respiration; Propofol

A study was conducted to polysomnographically evaluate the effects of external nasal dilation on sleep quality in mild snorers by examining the amount of sleep fragmentation and cyclic alternating pattern sequences (CAPS) rates. A two-night, open-label, one-way crossover polysomnographic evaluation, with and without use of an external nasal dilator, was done at the Tri-State Sleep Disorders Center in Cincinnati, Ohio. Nine snorers, polysomnographically determined to be free of clinically significant levels of obstructive sleep apnea, were studied. CAPS rates with nasal dilation were 28.4% as compared to 37.9% without nasal dilation (p < 0.05). We conclude that external nasal dilation reduces arousal instability in snorers without obstructive sleep apnea.

Topics: Airway Obstruction; Chi-Square Distribution; Cross-Over Studies; Dilatation; Humans; Nose; Polysomnography; Respiration; Sleep Stages; Snoring

We evaluated an auto-nasal continuous positive airway pressure (nCPAP) prototype (MC+; SEFAM, Nancy, France) in which apnoea/hypopnoea detection was disabled and nasal mask pressure vibration detection was the only mode of pressure setting. The device was tested in 15 previously untreated obstructive sleep apnoea patients during a night with polysomnography. We observed that a single night of auto-nCPAP improved the apnoea/hypnoea index (AHI) (12 +/- 21 vs 51 +/- 31 disordered breathing events.h-1 of sleep (mean +/- SD)), the awakening-arousal index (13 +/- 20 vs 40 +/- 26 arousals.h-1 of sleep), and duration of slow wave sleep (102 +/- 49 vs 71 +/- 56 min) but not of rapid eye movement (REM) sleep (55 +/- 31 vs 64 +/- 38 min). Auto-nCPAP was effective (apnoea/hypopnoea and arousal indices < 10 events.h-1) in all but three patients. Auto-nCPAP was ineffective in one patient, whose obstructive respiratory events were not preceded by nasal mask pressure vibration detection, and in two patients who were quasi-permanent mouth breathers. Snoring detection may be effective in sleep apnoea syndrome with heavy snoring and without permanent mouth breathing, during the first night of nasal continuous positive airway pressure treatment.

Topics: Airway Obstruction; Arousal; Awareness; Evaluation Studies as Topic; Humans; Male; Masks; Middle Aged; Mouth Breathing; Nose; Polysomnography; Positive-Pressure Respiration; Pressure; Sleep Apnea Syndromes; Sleep Stages; Sleep, REM; Snoring; Vibration

Airway maintenance and protection during anaesthesia and recovery provided by the reinforced laryngeal mask airway was compared with the sequential use of a tracheal tube followed by the Guedel airway in 66 patients having anaesthesia for nasal surgery. One patient was withdrawn from the laryngeal mask group because the airway was difficult to position. All patients had an oropharyngeal pack inserted and Moffett's solution instilled into the nasal cavities. At the end of surgery the nasal cavities were packed. During operation airway maintenance was good and airway protection was equally effective in both groups. Contamination of the lower airway occurred in only five patients. During recovery from anaesthesia the laryngeal mask and Guedel airway were well tolerated by most patients, but only the mask laryngeal provided an unobstructed airway in all patients. The laryngeal mask protects the larynx from contamination during and after operation until the return of the patient's own protective reflexes.

Topics: Adult; Aged; Airway Obstruction; Anesthesia, General; Female; Humans; Intubation, Intratracheal; Laryngeal Masks; Male; Middle Aged; Nose; Oxygen

Fifty ASA grade 1 children, who presented for dental outpatient extraction were studied. They were randomly allocated to two groups after induction: group 1 had conventional nasal mask anaesthesia and group 2 anaesthesia with a laryngeal mask. Group 2 had fewer hypoxic episodes and significantly better arterial oxygen saturations (p less than 0.01). There was no difference between the groups as regards surgical access, difficulty of extraction or bleeding. The laryngeal mask appears to provide an alternative to conventional nasal mask anaesthesia, with better overall oxygenation and would seem particularly suitable for prolonged or difficult extractions.

Topics: Airway Obstruction; Ambulatory Surgical Procedures; Anesthesia, Dental; Anesthesia, Inhalation; Anesthetics; Child; Child, Preschool; Humans; Intubation; Larynx; Masks; Nose; Oxygen; Tooth Extraction

The diagnosis and treatment of non-purulent rhinitis in the pediatric population poses a challenge to the clinician. In this randomized double blind study, the authors conclude that rhinometry is more effective than cytologic or symptomologic assessment in children with non-purulent rhinitis treated with either intranasal beclomethasone or placebo spray. Intranasal beclomethasone spray produced significant reductions in nasal airflow resistance values compared to the placebo-treated group.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Beclomethasone; Child; Double-Blind Method; Evaluation Studies as Topic; Female; Humans; Male; Manometry; Nasal Mucosa; Nose; Placebos; Random Allocation; Rhinitis

The effect of intranasally administered corticosteroid (budesonide) on nasal symptoms, mode of respiration (nasal versus mouth breathing), and asthma was investigated in 37 asthmatic children who were mouth breathers because of chronic nasal obstruction. After a 2-wk run-in period, the children were allocated randomly to 4 wk of intranasal therapy with either budesonide (400 micrograms/day) or placebo spray. A double-blind, parallel design was used. Diaries for peak expiratory flow, asthma, and rhinitis symptom scores and degree of mouth breathing were recorded at home. Nasal eosinophilia, nasal airway resistance at a flow of 0.2 L/s (NAR0.2), and lung function at rest and after exercise challenge were assessed at the clinic immediately before and at end of the 4-wk treatment. Budesonide, when compared with placebo, significantly decreased nasal obstruction (p less than 0.05), secretion (p less than 0.01), and eosinophilia (p less than 0.02), as well as NAR0.2 (p less than 0.05) and mouth breathing (p less than 0.01). The improvement in nasal obstruction correlated closely to the changes in mouth breathing (r = 0.80, n = 17, p less than 0.001). Furthermore, intranasally administered budesonide resulted in less exercise-induced asthma (EIA) (p less than 0.02) and decreased cough and asthma severity significantly. Pulmonary mechanics were only marginally improved. The present study showed that intranasally administered budesonide is effective in the treatment of perennial allergic rhinitis. An attenuation of EIA and a tendency to less asthma after budesonide therapy suggest a decrease in bronchial reactivity, but the results gave no clear evidence of an association between nasal airway function and asthma.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Double-Blind Method; Eosinophilia; Female; Humans; Male; Mouth Breathing; Nose; Nose Diseases; Peak Expiratory Flow Rate; Pregnenediones; Respiratory Function Tests

Anecdotal observations suggested that poor quality of sleep is a frequent complaint during upper respiratory infections (URI). Nasal obstruction occurs frequently during URI and causes sleep apnea in some infants. Sleep apnea disrupts normal sleep and could explain the complaints of poor sleep quality during URI in adults. Accordingly, 10 normal men had full night recordings of sleep stages and breathing rhythm before and during nasal obstruction. The order of obstructed and nonobstructed nights was randomized after a standard acclimatization night. During nasal obstruction, time spent in the deep sleep stages decreased from 90 +/- 11.2 (SEM) to 71 +/- 12.9 min (p less than 0.05), whereas significantly more time was spent in Stage 1 sleep (p less than 0.03). This loss of deep sleep during obstruction was associated with a twofold increase in sleep arousals and awakening (p less than 0.01) resulting from an increased (p less than 0.02) number of apneas (34 +/-19 during control sleep versus 86 +/- 34 during obstructed sleep). Apneas of 20 to 39 s in duration became 2.5 times more frequent (p less than 0.05) during obstruction. Oxygen saturation was studied in the last 4 subjects using an ear oximeter. Desaturation (SaO2 less than 90%) occurred 27 times during control sleep compared with 255 times during obstructed sleep. These desaturation episodes occurred only during apneas. All men complained of poor sleep quality during nasal obstruction. We concluded that apneas, sleep arousals and awakenings, and loss of deep sleep occur during nasal obstruction and may explain complaints of poor sleep quality during URI.

Topics: Adult; Airway Obstruction; Humans; Male; Middle Aged; Nose; Oximetry; Random Allocation; Respiratory Tract Infections; Sleep Apnea Syndromes; Sleep Stages; Sleep Wake Disorders

In 40 cases of acute epiglottitis in children, intubation was the chosen method for the management of airway obstruction. Six patients were treated without the establishment of an artificial airway, and no tracheostomies were done. No patients who were admitted to the hospital died of airway obstruction, although one sustained irreversible brain damage before admission, and two died of overwhelming infectionmthe average duration of intubation was 2.days and the average hospital stay was 5.days. Two children developed subglottic granulation tissue that was removed successfully and did not recur. Nasotracheal intubation is an acceptable method of management of epiglottitis.

Topics: Acute Disease; Airway Obstruction; Brain Damage, Chronic; Child; Child, Preschool; Clinical Trials as Topic; Epiglottis; Female; Granulation Tissue; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngitis; Laryngostenosis; Length of Stay; Male; Mouth; Nose; Pneumonia; Time Factors

Intraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring.. A 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated.. Acute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue's vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.

Topics: Airway Obstruction; Humans; Intubation, Intratracheal; Male; Middle Aged; Neck; Nose; Wakefulness

Topics: Airway Obstruction; Endoscopy; Humans; Incidence; Nose; Oxygen

Topics: Airway Obstruction; Anesthesiology; Edema; Humans; Laryngeal Edema; Nose; Pharynx

Topics: Airway Obstruction; Bronchoscopy; Humans; Nose; Trachea

Some patients with Robin sequence (RS) may respond to conservative therapy, while others require surgery; however, there are currently no objective anatomical criteria to gauge surgical indication. The purpose of this study was to explore the imaging characteristics of the mandible and upper respiratory tract in children with RS and examine how individual morphometric parameters influence the treatment strategy. Cone beam computed tomography (CBCT) images were obtained from 57 children with RS. Twenty parameters were measured as potential surgical indicators. The children were divided into two groups according to surgical requirement: a non-surgical group (26 children) and a surgical group (31 children who underwent mandibular osteodistraction). Differences in the imaging parameters were compared between the groups. The mandibular ramus was shorter bilaterally (left, P = 0.047; right, P = 0.027) and the mandibular body was longer bilaterally (left, P = 0.030; right, P = 0.025) in the surgical group when compared to the non-surgical group. In addition, the mandibular angle bilaterally (left, P = 0.023; right, P = 0.003) and the cross-sectional area at the epiglottis tip (P = 0.010) were smaller in the surgical group. Compared to RS patients receiving conservative treatment, children requiring surgery have specific anatomical features of the mandible and upper airway that can be used as surgical indications.

Topics: Airway Obstruction; Child; Humans; Mandible; Nose; Osteogenesis, Distraction; Pierre Robin Syndrome

Topics: Airway Obstruction; Humans; Nose

The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening.. A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously.. Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma.. To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement.. Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0 mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril.. In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program.

Topics: Adenocarcinoma of Lung; Airway Obstruction; Carcinoma, Squamous Cell; Female; Humans; Intubation; Lung Neoplasms; Middle Aged; Mouth; Mouth Neoplasms; Nose; One-Lung Ventilation; Spondylitis, Ankylosing

Upper airway foreign body is one of the most encountered clinical situations in otolaryngology practice. In rare conditions, a living organism may be a foreign body in the upper airway. In this study, we demonstrate 19 patients with leech infestations in nose, nasopharynx, and larynx.. This study was enrolled with 19 patients between 2012 and 2016 in a regional state hospital. All of the patients were admitted to clinic with these complaints: epistaxis, hemoptysis, coughing, foreign body sensation, and bloody stool.. There were 12 male and 7 female patients. The leech was in the nose in 12 patients, in nasopharynx in 6 patients, and in the larynx in only 1 patient. All leeches are removed under local anesthesia (except laryngeal presentation). No bleeding and complication were seen after extraction of leech.. Leech can be easily diagnosed and managed in the upper aero-digestive tract without any complication and leech-associated disease.

Topics: Adolescent; Adult; Airway Obstruction; Animals; Child; Child, Preschool; Female; Foreign Bodies; Humans; Larynx; Leeches; Male; Middle Aged; Nasopharynx; Nose; Retrospective Studies; Young Adult

Patients presenting with a unique unilateral cleft phenotype may be at risk of nasal airway obstruction which can be exacerbated by presurgical infant orthopedic (PSIO) appliance therapy and lip taping. Four patients presented to the UPMC Children's Hospital of Pittsburgh Cleft-Craniofacial Center with a cleft phenotype characterized by: An anteriorly projected greater alveolar segment and medial collapse of the lesser segment posteriorly, leading to cleft alar base displacement posteromedial to the anteriorly projected greater segment. Resultant bilateral nasal airway obstruction: cleft ala drape over the leading edge of the greater segment's alveolus (cleft side obstruction) and caudal septum displacement secondary to attachments to the orbicularis oris from the noncleft side (noncleft side obstruction). The patient described presented at 3 months old from an outside institution, where PSIO therapy was undertaken. A second opinion was sought due to concern of significant difficulty in breathing and feeding with the PSIO oral plate. Lip-nose adhesion (LNA) was elected and airway obstruction was immediately relieved after this intervention. Lip-nose adhesion releases the tethered cleft side alar base from the pyriform rim of the posteromedially collapsed lesser segment and unites the superior lip and nostril sill-relieving the cleft side nostril obstruction. During the LNA, the caudal septum is surgically released from the anterior nasal spine and is uprighted, relieving the obstructed noncleft nostril. In this cleft anatomy, the treatment alternatives of modification to the PSIO appliance or LNA should be carefully considered in consultation with the surgeon, PSIO provider, and the infant's caretakers.

Topics: Airway Obstruction; Child; Cleft Lip; Cleft Palate; Humans; Infant; Nose; Phenotype

Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (

Topics: Adult; Airway Obstruction; Body Mass Index; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Respiration; Sleep; Sleep Apnea, Obstructive; Surveys and Questionnaires; Treatment Outcome

Obstructive sleep apnoea hypopnoea syndrome associated with obesity poses major perioperative airway challenge. Drug-induced sleep endoscopy (DISE), is a real-time upper airway flexible fiberoptic nasoendoscopy in awake and sedation/anaesthesia-induced sleep. The aim of current study was to assess the correlation of bedside airway screening tests with level of obstruction during DISE.. Study was performed in endoscopy suite. Parameters calculated in 40 study group patients were Berlin questionnaire responses, Apnea hypopnea index (AHI), interincisor distance, Mallampati classification (MPC), neck circumference (NC), thyromental distance (TMD), NC/TMD ratio, sternomental distance (SMD), upper lip bite test, lateral cephalometry derived gonial angle and mentohyoid distance (MHD), Muller’s manoeuvre during awake nasoendoscopy, Croft–Pringle grade of airway obstruction during DISE and effect of jaw thrust.. All patients were American Society of Anesthesiologists physical status 1 and 2 with AHI > 30. Positive responses to Berlin questionnaire, body mass index and AHI increased with increasing grade of DISE. DISE grades 1–5 were observed in 0% (0), 5% (2), 37.5% (15), 27.5% (11) and 30% (12) patients respectively. Muller’s manoeuvre showed lateral wall collapse in 40% (16) patients and concentric collapse in 40% (16) patients. Airway patency improved with jaw thrust in 60% (24) patients. Significant association of DISE was found with MPC (p = 0.028), TMD (p = 0.003), MHD (p = 0.008) and NC/TMD ratio (p = 0.002), effect of Muller’s manoeuvre (p =0.002), and effect of jaw thrust (p = 0.000).. Bedside screening tests MPC, TMD, NC/TMD ratio and MHD correlate significantly with level of obstruction during DISE.

Topics: Adolescent; Adult; Aged; Airway Obstruction; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Sleep; Sleep Apnea, Obstructive; Young Adult

Crouzon syndrome is associated with severe respiratory impairment of the upper airway due in part to midfacial dysmorphology. We calculated the distinctive nasal diameter and pharyngeal airway volume in patients with Crouzon syndrome and compared them with age-matched control subjects.. Children with computed tomography scans in the absence of surgical intervention were included. Computed tomography scans were digitized and manipulated using Surgicase CMF (Materialise). Craniometric data relating to the midface and airway were collected. For all linear measurements, mean percent increases or decreases were calculated relative to the size of control subjects, and volumetric assessment of the airway was tabulated. Statistical analysis was performed using t test.. Twenty-six computed tomography scans were included (control n = 17, Crouzon n = 9). All children were in early mixed dentition. Pharyngeal airway volume was decreased in patients with Crouzon syndrome relative to control subjects by 46% (P = 0.003). The distance from the posterior tongue to the posterior pharyngeal wall decreased 31% when comparing the Crouzon group versus the control (P = 0.04).. Three-dimensional analysis revealed notably decreased pharyngeal and nasal airway volumes in patients with Crouzon syndrome, but nasal bone tissue and soft tissue measurements showed very little change between patients and control subjects.

Topics: Academic Medical Centers; Adolescent; Airway Obstruction; Case-Control Studies; Cephalometry; Child; Child, Preschool; Craniofacial Dysostosis; Facial Bones; Female; Humans; Imaging, Three-Dimensional; Male; Nose; Reference Values; Tomography, X-Ray Computed

This study aims to identify specific patterns of risk in order to contribute to the prevention of Foreign Body (FB) injuries by assessing FB injury characteristics in Indian children.. Single center case series are included in the worldwide registry on Foreign Bodies Injuries www.susysafe.org. Statistical analysis performed on FB injury data (age, medical information, FB anatomical location (ICD) and characteristics, and situational data) from 252 Indian children (0-14 years) was used to identify FB risk patterns.. The study included 252 FB injury cases, out of which 110 occurred in females (43.7%). Most of the reported FB injuries (N = 252) were located in the mouth, esophagus and stomach, or intestines and colon (34.5%), and in the nose (31.3%). The analysis of the median duration of all injuries (i.e., the difference between the reported injury time/date and the reported time/date of arrival at hospital) showed that children with a FB in the airways were those referred to the hospital latest (median of 332.50 min, p-value <0.001). With regards to FB type, the majority of FB objects were non-food items and ingestion of coins accounted for 25% of all FB injuries.. Cultural differences may exist with regards to the Indian diet being conducive to lower choking food risk for children, and to acceptability and accessibility to objects such as coins and stationery. Such findings should be taken into account when developing primary and secondary prevention strategies aimed at reducing the burden of such injuries in India.

Topics: Adolescent; Airway Obstruction; Child; Child, Preschool; Colon; Eating; Esophagus; Female; Foreign Bodies; Gastrointestinal Tract; Humans; India; Infant; Infant, Newborn; Intestine, Small; Male; Mouth; Nose; Registries; Risk Factors; Stomach; Wounds and Injuries

To assess the improvement of nasal morphologies and ventilation after septal cartilage graft and septoplasty of patients with unilateral cleft lip and palate (UCLP).. Retrospective case-control study.. Tertiary stomatology hospital.. In total, 118 patients with UCLP who had been diagnosed with a secondary nasal deformity and had reconstructive rhinoplasty and/or septoplasty between 2010 and 2015.. Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, septum deviated angle, rhinoplasty satisfaction questionnaire, and 3-dimensional photographs.. Average follow-up period was approximately 12 months for both groups. NOSE and 3-dimensional computed tomography (3DCT) analysis demonstrated postoperative improvement in nasal airway function of those patients who underwent rhinoplasty and septoplasty simultaneously ( P < .05). Subjective assessment by patients' visual analog scale (VAS) and objective assessment by 3-dimensional stereophotography demonstrated postoperative improvement in nasal morphologies, particularly the columella deviation angle and nasal depth (representing nasal tip height), which are crucial parameters of nasal aesthetics ( P < .05).. In patients who underwent simultaneous rhinoplasty and septoplasty, nasal symmetry and ventilation function were significantly improved compared to the control group. Septum grafts could provide nasal tip support for patients with cleft lip. Three-dimensional stereophotogrammetry helped us to better visualize the surgical results. Although the septal cartilage of Asian patients is sometimes insufficient for simultaneous use for multiple grafts, septum grafts in rhinoplasty of patients with cleft lip nasal deformities could give support for nasal tips.

Topics: Airway Obstruction; Case-Control Studies; China; Cleft Lip; Cleft Palate; Esthetics, Dental; Female; Humans; Image Processing, Computer-Assisted; Male; Nasal Septum; Nose; Photogrammetry; Plastic Surgery Procedures; Retrospective Studies; Rhinoplasty; Surgical Flaps; Surveys and Questionnaires; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Reporting our institutional experience with high-flow nasal oxygen therapy (HFNOT), a recently-introduced technique, for endoscopic airway approaches.. Prospective collection of data of children (<16 years) undergoing endoscopic between January 2016 and August 2017 at a tertiary referral university hospital.. HFNOT was used in 6 children who underwent 14 procedures for different forms and causes of upper airway obstruction of various origins. No intraoperative complications; related to oxygenation were observed, and the surgical procedures could be carried out as; initially planned.. We found that HFNOT is an effective and safe technique with a variety of potential applications in the field of endoscopic pediatric airway surgery.

Topics: Adolescent; Airway Obstruction; Child; Child, Preschool; Endoscopy; Female; Humans; Infant; Male; Nose; Oxygen; Oxygen Inhalation Therapy; Prospective Studies

One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway.. Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction.. Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA.. To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA.

Topics: Adult; Aged; Airway Obstruction; Endoscopy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nose; Palate; Pharynx; Prospective Studies; Sleep; Sleep Apnea, Obstructive; Young Adult

High-flow nasal oxygen (HFNO) has been shown to benefit oxygenation, ventilation and upper airway patency in a range of clinical scenarios, however its use in spontaneously breathing patients during general anaesthesia has not been described. Spontaneous respiration using i.v. anaesthesia is the primary technique used at our institution for tubeless airway surgery. We hypothesized that the addition of HFNO would increase our margin of safety, particularly during management of an obstructed airway.. A retrospective observational study was conducted using a SponTaneous Respiration using IntraVEnous anaesthesia and High-flow nasal oxygen (STRIVE Hi) technique to manage 30 adult patients undergoing elective laryngotracheal surgery.. Twenty-six patients (87%) presented with significant airway and/or respiratory compromise (16 were stridulous, 10 were dyspnoeic). No episodes of apnoea or complete airway obstruction occurred during the induction of anaesthesia using STRIVE Hi. The median [IQR (range)] lowest oxygen saturation during the induction period was 100 [99–100 (97–100)] %. The median [IQR (range)] overall duration of spontaneous ventilation was 44 [40–49.5 (18–100)] min. The median [IQR (range)] end-tidal carbon dioxide (ETCO2) level at the end of the spontaneous ventilation period was 6.8 [6.4–7.1 (4.8–8.9)] kPa. The mean rate of increase in ETCO2 was 0.03 kPa min−1.. STRIVE Hi succeeded in preserving adequate oxygen saturation, end-tidal carbon dioxide and airway patency. We suggest that the upper and lower airway benefits attributed to HFNO, are ideally suited to a spontaneous respiration induction, increasing its margin of safety. STRIVE Hi is a modern alternative to the traditional inhalation induction.

Topics: Airway Obstruction; Anesthesia, General; Anesthesia, Intravenous; Humans; Nose; Oxygen Inhalation Therapy; Respiration; Retrospective Studies; Treatment Outcome

The choice of mask interface used with continuous positive airway pressure (CPAP) therapy can affect the control of upper airway obstruction (UAO) in obstructive sleep apnea (OSA). We describe a case series of four patients with paradoxical worsening of UAO with an oronasal mask and the effect of changing to a nasal mask.. We retrospectively reviewed the case histories of 4 patients and recorded patient demographics, in-laboratory and ambulatory CPAP titration data, CPAP therapy data, type of mask interface used and potential confounding factors.. The 4 cases (mean ± SD: age = 59 ± 16 y; BMI = 30.5 ± 4.5 kg/m(2)) had a high residual apnoea-hypopnea index (AHI) (43 ± 14.2 events/h) and high CPAP pressure requirements (14.9 ± 6.6 cmH2O) with an oronasal mask. Changing to a nasal mask allowed adequate control of UAO with a significant reduction in the average residual AHI (3.1 ± 1.5 events/h). In two of the four cases, it was demonstrated that control of UAO was obtained at a much lower CPAP pressure compared to the oronasal mask (Case one = 17.5 cmH2O vs 12cmH2O; Case two = 17.9 cmH2O vs 7.8 cmH2O). Other potential confounding factors were unchanged. There are various physiological observations that may explain these findings but it is uncertain which individuals are susceptible to these mechanisms.. If patients have OSA incompletely controlled by CPAP with evidence of residual UAO and/or are requiring surprisingly high CPAP pressure to control OSA with an oronasal mask, the choice of mask should be reviewed and consideration be given to a trial of a nasal mask.. A commentary on this article appears in this issue on page 1209.

Topics: Adult; Aged; Airway Obstruction; Continuous Positive Airway Pressure; Equipment Design; Female; Humans; Male; Masks; Middle Aged; Nose; Oropharynx; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive

This guideline aims to promote high-quality care by medical specialists for subjects who snore and is designed for everyone involved in the diagnosis and treatment of snoring in an in- or outpatient setting.. To date, a satisfactory definition of snoring is lacking. Snoring is caused by a vibration of soft tissue in the upper airway induced by respiration during sleep. It is triggered by relaxation of the upper airway dilator muscles that occurs during sleep. Multiple risk factors for snoring have been described and snoring is of multifactorial origin. The true incidence of snoring is not clear to date, as the incidence differs throughout literature. Snoring is more likely to appear in middle age, predominantly in males. Diagnostic measures should include a sleep medical history, preferably involving an interview with the bed partner, and may be completed with questionnaires. Clinical examination should include examination of the nose to evaluate the relevant structures for nasal breathing and may be completed with nasal endoscopy. Evaluation of the oropharynx, larynx, and hypopharynx should also be performed. Clinical assessment of the oral cavity should include the size of the tongue, the mucosa of the oral cavity, and the dental status. Furthermore, facial skeletal morphology should be evaluated. In select cases, technical diagnostic measures may be added. Further objective measures should be performed if the medical history and/or clinical examination suggest sleep-disordered breathing, if relevant comorbidities are present, and if the subject requests treatment for snoring. According to current knowledge, snoring is not associated with medical hazard, and generally, there is no medical indication for treatment. Weight reduction should be achieved in every overweight subject who snores. In snorers who snore only in the supine position, positional treatment can be considered. In suitable cases, snoring can be treated successfully with intraoral devices. Minimally invasive surgery of the soft palate can be considered as long as the individual anatomy appears suitable. Treatment selection should be based on individual anatomic findings. After a therapeutic intervention, follow-up visits should take place after an appropriate time frame to assess treatment success and to potentially indicate further intervention.

Topics: Adult; Airway Obstruction; Algorithms; Cooperative Behavior; Endoscopy; Germany; Humans; Interdisciplinary Communication; Mandibular Advancement; Nasopharynx; Nose; Occlusal Splints; Otorhinolaryngologic Surgical Procedures; Polysomnography; Sleep Apnea, Obstructive; Snoring; Sound Spectrography; Tomography, Optical Coherence

Topics: Airway Obstruction; Equipment Design; History, 20th Century; Humans; Infant, Newborn; Masks; Nasal Obstruction; Nose; Pediatrics; Respiratory Function Tests

The purposes of this study were to investigate the dental arch changes after adenotonsillectomies in prepubertal children and to compare the dental arch dimensions of mouth-breathing and nasal-breathing children.. The sample included 49 prepubertal severely obstructed mouth-breathing children and 46 prepubertal nasal-breathing children. Twenty-four of the 49 mouth-breathing children had an adenotonsillectomy and composed the adenotonsillectomy subgroup. The 25 children in whom the mouth-breathing pattern was unchanged during the 1-year study period composed the control subgroup.. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children. After airway clearance, the adenotonsillectomy group showed a significant maxillary transverse width gain compared with the control subgroup. The control subgroup showed a significant deepening of the palatal height when compared with the adenotonsillectomy subgroup after 1 year.. The adenotonsillectomy subgroup had a significantly different pattern of arch development compared with the untreated controls. After adenotonsillectomy, the mouth-breathing children showed greater maxillary transverse development than did the controls. The palatal vault deepened in the untreated children. The mouth-breathing children showed a deeper palatal vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children.

Topics: Adenoidectomy; Airway Obstruction; Case-Control Studies; Cephalometry; Child; Child, Preschool; Cohort Studies; Cuspid; Dental Arch; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Malocclusion, Angle Class II; Mandible; Maxilla; Molar; Mouth Breathing; Nasopharyngeal Diseases; Nose; Open Bite; Palate; Palatine Tonsil; Puberty; Respiration; Tonsillectomy

Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation.

Topics: Administration, Inhalation; Airway Obstruction; Antibodies, Viral; Bronchiolitis, Viral; Coronavirus; Coronavirus Infections; Helium; Humans; Hypoxia; Infant; Intubation; Male; Nose; Oxygen

In patients with neuromuscular disorders, no randomized studies have been performed whether nasal or oronasal masks should be preferred. Oronasal masks are often used in acute respiratory failure, while nasal masks are preferred in patients with chronic respiratory failure. However, the use of nasal masks can result in mouth leaks with implications on sleep quality. To reduce these leaks, oronasal masks have been applied during home noninvasive ventilation (NIV). Until now, upper airway obstruction during NIV has been thought to be induced by nasal obstruction, pharyngeal collapse, and/or glottis closure. We report a case indicating another cause of upper airway obstruction: use of an oronasal mask can induce obstructive events in the upper airways, possibly resulting in sleep fragmentation and decreased efficiency of NIV.

Topics: Airway Obstruction; Amyotrophic Lateral Sclerosis; Equipment Design; Humans; Male; Masks; Middle Aged; Mouth; Noninvasive Ventilation; Nose; Polysomnography; Respiratory Insufficiency

Trichorhinophalangeal syndrome type I is a rare autosomal dominant disorder characterized by cone-shaped epiphysis, sparse fine hair, pear-shaped nose and variable growth retardation. The typical craniofacial features include thin upper lip, elongated philtrum, large outstanding ears, shortened posterior facial height associated with short mandibular ramus and reduced and superiorly deflected posterior cranial base. This report describes a 17-year-old male patient with trichorhinophalangeal syndrome type I and a detailed description of the craniofacial radiographic findings, including the use of cone beam computed tomography images for determination of the airway and temporomandibular joint discrepancies.

Topics: Adolescent; Airway Obstruction; Cephalometry; Cone-Beam Computed Tomography; Facial Bones; Fingers; Hair Diseases; Humans; Langer-Giedion Syndrome; Male; Nose; Temporomandibular Joint Disorders

Topics: Airway Obstruction; Female; Foreign-Body Migration; Humans; Intraoperative Complications; Intubation, Intratracheal; Nose; Prostheses and Implants; Prosthesis Failure; Silicones; Young Adult

Epignathus teratoma is a rare tumor whose prognosis essentially depends on its resectability and on neonatal care. When it is undiagnosed prenatally, mortality is close to 100 % at birth, because of obstruction of the upper airways. We present a case of epignathus teratoma detected during obstetrical ultrasound screening. Diagnosis enabled planning for a safe delivery in a suitable multidisciplinary unit and use of the EXIT procedure.

Topics: Adult; Airway Obstruction; Cesarean Section; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Larynx; Nose; Pregnancy; Prognosis; Teratoma; Tongue; Ultrasonography, Prenatal

The present study investigated whether cephalometric measurements can predict the therapeutic efficacy of multilevel phase I surgery for patients with obstructive sleep apnea (OSA).. Among 210 patients with OSA who underwent multilevel phase I surgery, 85 were recruited on the basis of the baseline polysomnography, body mass index, and lateral cephalogram recordings. The patients were divided into 2 groups according to the degree of change in the apnea-hypopnea index before and 6 months after multilevel surgery: good responders (>50% decrease in apnea-hypopnea index) and poor responders (0% to 50% decrease or increase in apnea-hypopnea index). Cephalometric analysis was performed to identify the relevant variables, with division into 5 compartments: craniofacial, soft palate, tongue, hyoid bone, and upper airway variables.. In the craniofacial compartment, poor responders represented skeletal Class II with a more retrognathic mandible, and a hyperdivergent vertical pattern with a larger mandibular plane angle, longer lower facial height, and steeper occlusal plane than good responders. In the upper airway compartment, poor responders had narrower middle and inferior airway spaces and a longer upper airway length than good responders. No significant differences were found in the soft palate, tongue, and hyoid measurements between the 2 groups.. Some preoperative cephalometric measurements were verified retrospectively to predict the therapeutic response to the multilevel surgery in patients with OSA. This study would contribute not only to establishing selective criteria for the surgical approach to patients with OSA in ear-nose-throat practice but also in deciding on the referral to orthodontists or maxillofacial surgeons.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Facial Bones; Humans; Hyoid Bone; Malocclusion, Angle Class II; Mandible; Middle Aged; Nose; Palate, Hard; Palate, Soft; Patient Selection; Pharynx; Polysomnography; Predictive Value of Tests; Regression Analysis; Retrognathia; Retrospective Studies; Sleep Apnea, Obstructive; Tongue; Treatment Outcome; Vertical Dimension

To propose an algorithm for the preoperative management of patients with obstructive sleep apnea syndrome (OSAS) and review the surgical outcomes in such patients.. This prospective cohort study involved 71 patients with OSAS who underwent presurgical upper airway endoscopy and cephalometry before being assigned to treatment categories based on the site(s) of obstruction, the pattern of collapse, the characteristics of the soft tissue, the air space between the base of the tongue and the posterior wall of the pharynx, and the severity of OSAS. Six months after surgery, they were followed up using polysomnography and the Epworth Sleepiness Scale. The pre- and postsurgical data were compared using a paired Student t test.. The mean preoperative apnea/hypopnea index of the 71 patients (61 male and 10 female) was 40.98 events/hour (range, 14.7 to 87.6 events/hr), and the mean postoperative apnea/hypopnea index was 13.96 events/hour (range, 0 to 20 events/hr). The difference was statistically significant (P < .001).. This algorithm was developed on the principle that every patient with OSAS should be considered individually. In the authors' opinion, taking into account the number, site(s), pattern, and degree of the collapse/obstruction is a reasonable means of ensuring the correct diagnosis and treatment.

Topics: Adult; Aged; Airway Obstruction; Algorithms; Cephalometry; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Humans; Hypopharynx; Male; Middle Aged; Nasal Obstruction; Nose; Oropharynx; Orthognathic Surgical Procedures; Patient Care Planning; Pharyngeal Diseases; Polysomnography; Preoperative Care; Prospective Studies; Sleep Apnea, Obstructive; Sleep Stages; Tongue; Treatment Outcome

Foreign body aspiration is a commonly encountered emergency in children. Foreign body can lodge in any site from supra-glottis to the terminal bronchioles. Symptoms might range from none to respiratory compromise, cardiac arrest and even death depending on location and size. We report successful management of a child who aspirated a nasal foreign body during physical examination in an outpatient department causing complete airway obstruction with special mention about different management options available for managing near total respiratory arrest from an aspirated foreign body in the ED.

Topics: Airway Obstruction; Child, Preschool; Female; Foreign Bodies; Foreign-Body Migration; Humans; Nose; Respiratory Aspiration

Topics: Airway Obstruction; Animals; Humans; Larynx; Nose; Pulmonary Ventilation; Species Specificity; Vocal Cords

Selective breeding for exaggerated features caused in many brachycephalic dog and cat breeds virtually a loss of the nose, with serious anatomical and functional consequences. In addition to respiratory and olfactory tasks, in dogs the nose is of vital importance for thermoregulation. As obligatory nose breathers, dogs suffer far more than humans when their nasal ventilation is restricted. An open discussion in the broad public has to motivate authorities and kennel clubs to recognize extreme brachycephalic breeding as seriously affecting animal health and welfare.

Topics: Airway Obstruction; Animal Welfare; Animals; Body Temperature Regulation; Breeding; Cat Diseases; Cats; Craniosynostoses; Dog Diseases; Dogs; Humans; Nose; Paranasal Sinuses; Selection, Genetic; Smell; Species Specificity; Tomography, X-Ray Computed

Our objective was to investigate the occurrence of sleep-related breathing disturbances in a large cohort of school-aged children in Southern Italy, and to evaluate the association with anthropometric data and clinical findings of oropharynx and nasal airways.. A two-phase cross-sectional study was conducted with children from schools in Turi, Italy.. A screening phase aimed to identify symptomatic children and clinical data from a cohort of 495 children by a self-administered questionnaire, and an instrumental phase for the definition of sleep-related disorders and clinical analysis of oral status were performed. According to the answers, children were classified into 3 groups: habitual snorers, occasional snorers, and non-snorers. All habitual snoring children underwent a polysomnographic home evaluation, and those with oxygen desaturation index (ODI) > 2 were considered for nocturnal polygraphic monitoring (NPM). Children with apnoea/ hypopnea index (AHI) > 3 received a diagnosis of obstructive sleep apnoea syndrome (OSAS). Moreover, a complete oral examination was performed.. A total of 436 questionnaires (response rate: 88.08%) were returned and scored (202 M, 234 F; Mean age ± Standard deviation: 6.2 ± 1.8); 18 children (4%) were identified as habitual snorers, 140 children (32%) were identified as occasional snorers, and 278 children (64%) were identified as non-snorers. The percentage of female children who were habitual snorers was higher than the percentage of male children (4.7% vs 3.6%). Habitual snorers had significantly more nighttime symptoms. OSAS was diagnosed in 2 children by NPM. A statistically significant association between snoring, cross-bite, open-bite and increased over-jet was found.. Habitual snoring and OSAS are significant problems for children and may be associated with diurnal symptoms. The presence of malocclusion increases the likelihood of sleep-related breathing disturbances.

Topics: Airway Obstruction; Bronchitis; Child; Child, Preschool; Female; Humans; Italy; Male; Nose; Open Bite; Oropharynx; Otitis; Overbite; Prevalence; Sinusitis; Sleep Apnea, Obstructive; Snoring; Surveys and Questionnaires; Tonsillitis

The purpose of the study was to compare in vitro airway responses to neurokinin A & B (NKA and NKB) and expression of NK-2 receptors in airways of horses affected and unaffected with recurrent airway obstruction (RAO). Neurokinin-A, an inflammatory mediator belonging to the tachykinin family of neuropeptides, causes bronchoconstriction by binding to NK-2 receptors. Neurokinin-B is a lesser-known neuropeptide that acts on NK-3 receptors. Horses were placed into RAO-affected and RAO-unaffected groups based on their history, clinical scoring, and pulmonary function testing. Lung tissue from each lobe was collected for immunohistochemical staining for NK-2 receptors. Cumulative concentration-response relationships were determined on bronchial rings (4-mm wide) collected and prepared from the right diaphragmatic lung lobe to graded concentrations (half log molar concentrations 10(-7)M to 10(-4)M) of NKA and NKB. The results showed that NKA caused significantly greater contraction than NKB in both groups. In RAO-affected horses, both agents produced significantly greater bronchial contractions than those in the RAO-unaffected horses. Immunohistochemical staining showed that the overall NK-2 receptor distribution was significantly increased in bronchial epithelium and smooth muscles of bronchi and pulmonary vessels of RAO-affected than RAO-unaffected horses. The findings indicate that NK-2 receptors are up-regulated in RAO, suggesting that NK-2 receptor antagonists may have some therapeutic value in controlling the progression of airway hyperreactivity in horses affected with RAO.

Topics: Airway Obstruction; Animals; Antibodies; Bronchi; Bronchial Hyperreactivity; Horse Diseases; Horses; Immunohistochemistry; Muscle, Smooth; Neurokinin A; Neurokinin B; Nose; Receptors, Neurokinin-2; Recurrence; Respiratory Physiological Phenomena

To provide a detailed description of the nasopharyngeal intubation (NPI) technique and photographs, which should be helpful for those who may need to perform it for treating the airway obstruction in Robin sequence.. To describe and illustrate the NPI technique and the necessary considerations for its application.. Hospital de Reabilitação de Anomalias Craniofacial of University of São Paulo, Brazil.. The NPI procedure involves the use of a whitish, Portex, number 3.0 or 3.5, silicone tube, introduced 8 cm deep into the infant's nostril and fixed with Micropore tape. The tube is to be removed at least twice a day for proper hygiene (with running water, detergent, and swabs) and should be changed every 7 days. This procedure is taught to the children's parents or caretakers by the nurse during hospitalization.. The technique is so simple that it can be performed by the parents themselves, allowing continuation of the treatment at home.

Topics: Airway Obstruction; Equipment Design; Humans; Infant; Intubation; Nasopharynx; Nose; Photography; Pierre Robin Syndrome; Silicones; Surgical Tape

Two unusual autopsy cases of fatal Ascaris infection have been presented. The first case presents lethal diffuse peritonitis due to duodenal rupture caused by the presence of parasitic Ascaris worm in gastrointestinal tract of 2.5-year-old child. The second one is a case of subacute asphyxia caused by obturation of upper respiratory tract by a large number of adult Ascaris roundworms. General economic crisis and inefficient medical service make possible spreading of almost eradicated disease, thus the possibility of the most serious complications of this helminthiasis must not be forgotten.

Topics: Airway Obstruction; Animals; Ascariasis; Asphyxia; Child, Preschool; Duodenum; Esophagus; Female; Forensic Pathology; Humans; Infant, Newborn; Larynx; Leukocytes; Male; Malnutrition; Nose; Peritoneum; Peritonitis; Rupture, Spontaneous

The most recent U.S. statistics (2005) determined that 22.2% of suicides are by suffocation. This number likely includes suicidal hanging. Based on previous reports the majority of nonhanging suicidal asphyxiations are accomplished by securing a plastic bag over the head. We report two instances of a far less common method of suicidal asphyxiation, occlusion of the nose and mouth by duct tape. One was a 47-year-old man with a history of paranoid schizophrenia with suicidal ideation and the other was a 52-year-old man who was depressed due to gambling debts. The value of scene investigation, including review of available video surveillance to determine the manner of death is highlighted.

Topics: Airway Obstruction; Asphyxia; Forensic Medicine; Humans; Male; Middle Aged; Mouth; Nose; Suicide

The nasopharyngeal airway is a simple airway adjunct used by various healthcare professionals. It is the least invasive method of safely managing upper airway obstruction. The objective of this report was to describe a rapid and very simple method of securing a nasopharyngeal airway in an agitated patient.. We describe a simple method of securing a nasopharyngeal airway, using safety pins and tapes.. This technique has been used by the authors in several emergency situations and has been found to be quick and effective.. The nasopharyngeal airway is a simple piece of equipment that is cheap and easy to use. The technique described in this article is a simple, practical and effective method of securing a nasopharyngeal airway in an emergency situation.

Topics: Airway Obstruction; Emergency Medicine; Equipment Design; Humans; Intubation; Nasopharynx; Nose

Gradual midfacial advancement, applying the principle of distraction osteogenesis, reduces the restriction of the soft tissues and results in bony consolidation without need for grafting. The midface can be distracted by either pushing it forward, using semiburied devices, or pulling it forward by a rigid external device. For each method there are inherent technical problems, such as controlling the vector of movement, symmetry of advancement, and differential movement of the upper/lower face. We have used a combination of the 2 methods, called "push-pull," in an effort to control the distraction process. The purpose of this paper is to describe our push-pull distraction technique and summarize our early experience.. Ten patients (5 males and 5 females) with a mean age of 11 years 2 months underwent midfacial advancement using push-pull distraction. Two orthodontists, blinded for landmark identification, traced preoperative and postoperative cephalograms and determined linear and angular measurements of midfacial position. A Student t test was used to assess differences between the cephalometric measures on the 2 radiographs. Interexaminer reliability was calculated by an intraclass correlation coefficient.. Postdistraction cephalograms were taken a mean of 10 months (range, 3 to 20 months) after removal of the devices. Patients exhibited improvement at all levels of the midface after distraction. There was a statistically significant sagittal advancement from the infraorbital rim to dentoalveolus. The central midface was sufficiently advanced as shown by an improved convexity, nasolabial angle, and upper labial protrusion. There were no significant differences between examiners for any of the measurements in this study.. Push-pull distraction permits 1) equal movement at both the upper and lower facial levels, 2) advancement of the central midface, and 3) symmetric movement of the zygomaticomaxillary complexes. This method also provides a backup, in case one device malfunctions. In combination, the advantages of each device are additive; whereas the weaknesses are not. The push-pull technique is a practical method for midfacial distraction until a better single device is fabricated.

Topics: Acrocephalosyndactylia; Adolescent; Airway Obstruction; Alveolar Process; Cephalometry; Child; Child, Preschool; Craniofacial Dysostosis; Female; Follow-Up Studies; Humans; Lip; Male; Maxilla; Maxillofacial Abnormalities; Nose; Orbit; Osteogenesis, Distraction; Osteotomy, Le Fort; Single-Blind Method; Syndrome; Zygoma

Topics: Aged; Airway Obstruction; Humans; Intubation; Male; Nose

Topics: Absorbable Implants; Airway Obstruction; Cartilage; Humans; Inhalation; Nasal Cavity; Nose; Photography; Rhinoplasty

Topics: Airway Obstruction; Burns; Humans; Male; Nose; Nose Deformities, Acquired; Rhinoplasty; Surgical Flaps

This prospective, cohort study evaluated the role of sleep nasendoscopy (SNE) with simultaneous mandibular protrusion in predicting successful mandibular advancement splint (MAS) therapy in subjects with obstructive sleep apnoea (OSA). Nineteen OSA subjects diagnosed by overnight polysomnography were referred for MAS therapy, following SNE investigation. A Herbst MAS was fabricated for each subject. Once this had been adjusted for maximal, subjective, therapeutic effect, follow-up sleep studies were undertaken with the appliance in situ. The SNE was repeated with the appliance in place to allow the effects of the original mandibular protrusion and the actual effect of the MAS to be compared. The MAS was removed and the original and current site(s) of obstruction evaluated. Pre-treatment SNE showed airway obstruction at the following levels: intermittent multi-level (16 subjects), sustained multi-level (two subjects) and tongue base (one subject). In all individuals, gentle advancement of the mandible during SNE improved airway patency and reduced snoring. When the SNE was repeated with the MAS in situ, all subjects showed improvements in snoring and airway patency. Follow-up sleep studies confirmed the efficacy of the MAS, with all patients showing a reduction in the apnoea/hypopnoea index (AHI). Median reductions in AHI (from 28.1 to 6.1, P < 0.001) and Epworth Sleepiness Scale (ESS) scores (from 9 to 6, P < 0.001) were highly statistically significant. The results suggest that SNE with concomitant mandibular advancement to mimic MAS wear, could be a valuable prognostic indicator of successful MAS treatment.

Topics: Adult; Aged; Airway Obstruction; Cohort Studies; Endoscopy; Female; Follow-Up Studies; Forecasting; Humans; Male; Mandibular Advancement; Middle Aged; Nose; Occlusal Splints; Orthodontic Appliances, Functional; Polysomnography; Prospective Studies; Pulmonary Ventilation; Sleep; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Treatment Outcome

The purpose of this study was to evaluate mandibular lengthening by distraction osteogenesis (DO) to achieve decannulation of micrognathic children with "permanent" tracheostomies.. Using a retrospective chart review, patients were included who had 1 ) airway compromise/tracheostomy, 2 ) micrognathia, 3 ) polysomnography-documented obstructive apnea, and 4 ) mandibular advancement using DO. Excluded were 1 ) adults, 2 ) neonates without tracheostomy, and 3 ) patients with central apnea. Patient age, past medical history, age at tracheostomy, and distraction protocol were documented. Oxygen saturation, posterior airway space (in millimeters), and sella-nasion-B point (SNB) angle were recorded. The distraction protocol consisted of a latency of 48 hours and a rate of 1 mm/day.. There were 5 children, aged 2 to 14 years, who received a tracheostomy between ages 2 and 36 months for airway obstruction. All patients underwent bilateral mandibular distraction using semiburied, unidirectional devices. The average latency was 58 hours, the rate was 1 mm/day, the duration of fixation was 40 to 60 days, and the magnitude of advancement was 23 mm. Healing was evaluated by clinical, radiologic, and ultrasound examinations. No complications were experienced. Mean follow-up was 3.2 years. Postdistraction sleep studies demonstrated no obstructive apneic events and a mean oxygen saturation of 98% (preoperative, 76%, P < .005). Cephalometric values improved: posterior airway space 4 to 14 mm; SNB 66 degrees to 72 degrees ( P < .005 for both variables). Four of the 5 patients have been successfully decannulated to date.. The results of this preliminary study indicate that mandibular advancement by DO is a potentially viable treatment option for tracheostomy-dependent children with upper airway obstruction secondary to micrognathia.

Topics: Adolescent; Airway Obstruction; Cephalometry; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Mandible; Mandibular Advancement; Micrognathism; Nose; Osteogenesis, Distraction; Oxygen; Polysomnography; Retrospective Studies; Sella Turcica; Sleep Apnea, Obstructive; Tracheostomy; Treatment Outcome; Wound Healing

Topics: Adult; Airway Obstruction; Anesthesia, General; Equipment Safety; Female; Gynecologic Surgical Procedures; Humans; Intubation, Intratracheal; Laryngoscopes; Nose; Sensitivity and Specificity

Mouth breathing may cause changes in muscle activity, because an upper airway obstruction leads may cause a person to extend his/her head forward, demanding a higher inspiratory effort on the accessory muscles (sternocleidomastoids). This purpose of this study is to compare, using electromyography (EMG), the activity pattern the sternocleidomastoid and upper trapezius muscles in mouth breathing children and nasal breathing children. Forty-six children, ages 8-12 years, 33 male and 13 female were included. The selected children were divided into two groups: Group I consisted of 26 mouth breathing children, and Group II, 20 nasal breathing children. EMG recordings were made using surface electrodes bilaterally in the areas of the sternocleidomastoideus and upper trapezius muscles, while relaxed and during maximal voluntary contraction. The data were analyzed using the Kruskall-Wallis statistical test. The results indicated higher activity during relaxation and lower activity during maximal voluntary contraction in mouth breathers when compared to the nasal breathers. It is suggested that the activity pattern of the sternocleidomastoid and upper trapezius muscles differs between mouth breathing children and nasal breathing children. This may be attributed to changes in body posture which causes muscular imbalance. Because of the limitations of surface EMG, the results need to be confirmed by adding force measurements and repeating the experiments with matched subjects.

Topics: Airway Obstruction; Child; Electromyography; Female; Humans; Male; Mouth Breathing; Muscle Contraction; Neck Muscles; Nose; Posture; Respiration; Rest; Statistics, Nonparametric

Sedative doses of anesthetic agents affect upper-airway function. Oral-maxillofacial surgery is frequently performed on sedated patients whose mouths must be as open as possible if the procedures are to be accomplished successfully. We examined upper-airway pressure-flow relationships in closed mouths, mouths opened moderately, and mouths opened maximally to test the hypothesis that mouth-opening compromises upper-airway patency during midazolam sedation. From these relationships, upper-airway critical pressure (Pcrit) and upstream resistance (Rua) were derived. Maximal mouth-opening increased Pcrit to -3.6 +/- 2.9 cm H2O compared with -8.7 +/- 2.8 (p = 0.002) for closed mouths and -7.2 +/- 4.1 (p = 0.038) for mouths opened moderately. In contrast, Rua was similar in all three conditions (18.4 +/- 6.6 vs. 17.7 +/- 7.6 vs. 21.5 +/- 11.6 cm H2O/L/sec). Moreover, maximum mouth-opening produced an inspiratory airflow limitation at atmosphere that was eliminated when nasal pressure was adjusted to 4.3 +/- 2.7 cm H2O. We conclude that maximal mouth-opening increases upper-airway collapsibility, which contributes to upper-airway obstruction at atmosphere during midazolam sedation.

Topics: Adult; Airway Obstruction; Airway Resistance; Conscious Sedation; Humans; Hypnotics and Sedatives; Inhalation; Male; Midazolam; Mouth; Nose; Pharynx; Polysomnography; Pressure; Pulmonary Ventilation

The purpose of the study is to describe a commonly overlooked etiology of nasal airway obstruction. Collapse of the nasal valve can be corrected with precise placement of cartilage grafts. This study demonstrates the surgical technique, rarely described in the literature, of placing a contoured cartilage graft in the nasal valve region for the improvement of the nasal airway.. Retrospective review of surgical results of the 21 patients who underwent alar batten grafting performed over a 3-year period at the Geisinger Medical Center (Danville, PA).. A retrospective review was conducted of 21 patients surgically treated with alar batten grafts for nasal valvular collapse between the 1997 and 1999. The surgical technique is described, and our results are analyzed including for both functional and aesthetic outcome.. All patients treated with alar batten grafting at the nasal valve improved with regard to their airway obstruction. There were no complications, and there was only minor aesthetic fullness in six cases.. Alar batten cartilage grafting is an easy, highly effective therapeutic measure in the treatment of nasal valve collapse. The surgical technique is demonstrated.

Topics: Adult; Airway Obstruction; Cartilage; Female; Graft Survival; Humans; Male; Nose; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome

The last decade has witnessed a proliferation of devices or methods that facilitate intubation in difficult circumstances, maintain ventilation, or which do both. These all require properly functioning and specially designed apparatus, the use of which requires variable degrees of expertise. This technical communication describes the author's experience with a simple technique that uses virtually universally available materials--a nasal trumpet (airway) and an endotracheal tube (ETT) connector--to rescue patients in the cannot-ventilate/cannot-intubate scenario. The methodology is straightforward, ventilation is usually immediate, stomach contents can be evacuated while ventilation proceeds, and it does not require mouth opening. Moreover, while ventilation and oxygenation is continuing, a fiber-optic intubation can proceed without interference.. A simple technique is proposed that can be used to rescue patients who are in a condition of cannot intubate/cannot ventilate. The described maneuver may save patients from requiring a surgical airway.

Topics: Adult; Airway Obstruction; Emergencies; Humans; Intubation; Nose; Positive-Pressure Respiration; Respiration, Artificial

Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy, and therefore, mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the long-term effect of mandibular setback surgery on the airway size. The material consisted of pre- and postoperative (minimum 1 year) lateral radiograms of 22 individuals (18 females and 4 males) with a mean age of 30 years, who had undergone mandibular setback surgery to correct skeletal Class III discrepancies. Hard and soft tissue points were digitized with a Numonics Accugrid digitizer and analyzed with Xmetrix software. A paired t test was used to evaluate the difference between pre- and postoperative measurements. In addition, Pearson's coefficient correlation was calculated to reveal the possible association between the skeletal change in relation to the change in airway size. The mean value for the initial SNA was 81.3 degrees, 85.4 degrees for SNB, 36.9 degrees for S-Na/MP, and for the posterior airway, 10.5 mm and 12.0 mm retropalatinally and retrolingually, respectively. At the postoperative evaluation, SNB was 80.7 degrees, S-Na/MP 41.0 degrees, and the posterior airway retropalatinally 8.3 mm and retrolingually 9.8 mm. Statistical analysis revealed a highly significant correlation between the change in the ANB angle and in the S-Na/MP angle versus the change in the upper airway size, both retropalatinally and retrolingually. Mandibular setback surgery with posterior rotation may gradually result in increased upper airway resistance in cases where neuromuscular adaptation is insufficient to compensate for the reduction in the airway size. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Cephalometry; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Longitudinal Studies; Male; Malocclusion, Angle Class III; Mandible; Matched-Pair Analysis; Maxilla; Middle Aged; Nose; Osteotomy; Palate; Rotation; Sella Turcica; Statistics as Topic

The sensitivity of a simplified variant of forced oscillation technique (FOT) was studied for assessment of dynamic upper airway obstruction during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA). The airway impedance P[FOT] was measured by FOT and the oesophageal pressure (P(oes)) was recorded during stable stage II sleep in 11 patients with OSA. The CPAP level was initially set high enough to completely abolish upper airway obstruction. To induce gradually increasing upper airway re-obstruction, the CPAP pressure was then lowered stepwise. Thirty six such manoeuvres were analysed, blind, to define the first inspiration at which upper airway re-obstruction was detectable by analysis of P[FOT](t(FOT)) and by P(oes)(t(oes)), respectively. On seven occasions t(FOT) and t(oes) occurred together, in the remaining 29 cases t(FOT) preceded t(oes) with a mean latency of 6.0+/-7.7 (0-32) breath cycles. In no case did t(oes) preceed t(FOT). FOT is a highly sensitive tool for the assessment of incipient upper airway obstruction during nCPAP therapy.

Topics: Aged; Airway Obstruction; Esophagus; Humans; Middle Aged; Nose; Oscillometry; Positive-Pressure Respiration; Pressure; Reaction Time; Sensitivity and Specificity; Single-Blind Method; Sleep Apnea Syndromes

Increased resistance in the upper airway is known to be a contributing factor to deviant facial growth patterns. These patterns are the result of a prolonged presence of unbalanced oropharyngeal muscle activity. We hypothesized that mechanically increasing airway resistance would enhance the activity of the muscles facilitating respiration, and we attempted to demonstrate that the increased muscle activity is modulated by mechanoreceptors in the pharyngeal airway. The response of oropharyngeal muscles to increased airway resistance during spontaneous breathing was observed in 11 rabbits. Electromyographic signals from the ala nasi, orbicularis oris superior, genioglossus, mylohyoid muscles, and the diaphragm were recorded by fine-wire electrodes. Pressure changes were monitored by pressure transducers at the side branch of the cannule close to openings for the nose and the trachea. The study consisted of 2 experimental sessions. First, to evoke the response of muscles to the inspiratory resistance, increasing stepwise polyethylene tubes of various diameters were attached to the nasal and tracheal opening and the diameter of the tubes was gradually reduced. Muscle activity changes in response to the increased resistance were recorded during spontaneous nasal or tracheal breathing. Second, to examine muscle responses to negative pressure to the pharyngeal airway, irrespective of breathing activity, the pharynx was isolated as a closed circuit by a stoma constructed at a more caudal side in the trachea. Muscle responses to the negative pressure generated by a syringe in the pharyngeal segment were measured. Nasal breathing induced a greater muscle activity than did tracheal breathing, in general, at P <.05. When resistance was gradually increased, nasal breathing resulted in a greater increase in muscle activity than did tracheal breathing (P <.05), except in the diaphragm. Application of negative pressure to the isolated pharyngeal airway segment increased the muscle activity significantly (P <.05). We conclude that an increased airway resistance may facilitate oropharyngeal muscle activity through mechanoreceptors in the oropharyngeal airway.

Topics: Airway Obstruction; Airway Resistance; Animals; Diaphragm; Electrodes, Implanted; Electromyography; Facial Muscles; Inhalation; Intubation; Intubation, Intratracheal; Mechanoreceptors; Mouth; Muscle Contraction; Neck Muscles; Nose; Oropharynx; Pharyngeal Muscles; Pressure; Rabbits; Respiratory Insufficiency; Respiratory Physiological Phenomena; Trachea; Transducers, Pressure

To determine the diagnostic utility of a nasal cannula/pressure transducer (NC), in comparison to thermistor (TH), during routine, clinical nocturnal polysomnography (NPSG).. We analyzed the respiratory arousal index (RAI) using TH (RAI-TH) or NC (RAI-NC) in patients with suspected sleep-disordered breathing (SDB).. Sleep disorders center of a university-affiliated teaching hospital.. Fifty consecutive, nonselected patients referred for evaluation of suspected SDB.. Twenty patients were found to have obstructive sleep apnea/hypopnea syndrome (OSA), 25 had upper airway resistance syndrome (UARS), and 5 had primary snoring (PS). Mean RAI-NC was greater than the mean RAI-TH by 25%, 302%, and 500% in OSA, UARS, and PS, respectively. RAI-NC was >/= 14 (mean, 25.2) in UARS and < 14 (mean, 9) in PS. Mean RAI-TH was 8.4 in UARS and 1.8 in PS, with significant overlap between the two groups.. NC is more sensitive than TH in detecting respiratory events during NPSG and may represent a simple, objective means to identify UARS among patients with a range of SDB.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Airway Resistance; Catheterization; Circadian Rhythm; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Retrospective Studies; Sensitivity and Specificity; Sleep Apnea Syndromes; Snoring; Syndrome; Transducers, Pressure

The increase in systemic blood pressure after an obstructive apnea is due, in part, to sympathetically mediated vasoconstriction. We questioned whether upper airway (UA) receptors could contribute reflexly to this vasoconstriction. Four unanesthetized dogs were studied during wakefulness and non-rapid-eye-movement (NREM) sleep. The dogs breathed via a fenestrated tracheostomy tube sealed around the tracheal stoma. The snout was sealed with an airtight mask, thereby isolating the UA when the fenestration was closed and exposing the UA to negative inspiratory intrathoracic pressure when it was open. The blood pressure response to three UA perturbations was studied: 1) square-wave negative pressures sufficient to cause UA collapse with the fenestration closed during a mechanical hyperventilation-induced central apnea; 2) tracheal occlusion with the fenestration open vs. closed; and 3) high-frequency pressure oscillations (HFPO) with the fenestration closed. During NREM sleep, 1) blood pressure response to tracheal occlusion was similar with the fenestration open or closed; 2) collapsing the UA with negative pressures failed to alter blood pressure during a central apnea; and 3) application of HFPO to the UA during eupnea and resistive-loaded breaths increased heart rate and blood pressure. However, these changes were likely to be secondary to the effects of HFPO-induced reflex changes on prolonging expiratory time. These findings suggest that activation of UA pressure-sensitive receptors does not contribute directly to the pressor response associated with sleep-disordered breathing events.

Topics: Airway Obstruction; Airway Resistance; Animals; Blood Pressure; Disease Models, Animal; Dogs; Electromyography; Female; Heart Rate; Hemodynamics; Larynx; Nose; Polysomnography; Pressure; Sleep; Sleep Stages; Snoring; Trachea

Topics: Airway Obstruction; Bandages; Bulbar Palsy, Progressive; Dilatation; Fatal Outcome; Female; Humans; Middle Aged; Motor Neuron Disease; Nose

Topics: Airway Obstruction; Child; Female; Humans; Nose; Respiration

This work presents long term results of rhinopharyngeal desobstructions on nine years old patients. By using several techniques such as: tonsillectomies, adenoïdectomy, adenoïdotonsillectomies, luxation of inferior turbinates, partial turbinectomies or bilateral turbinectomies under endoscopic guidance, and then, following carefully the oral and nasal peak flows for a period as long as one or two years, it becomes obvious that the most efficient desobstruction procedure is accomplished through a combination of E.N.T. rhinopharyngeal procedures, i.e. adenoïdotonsillectomies and inferior turbinectomies under endoscopic guidance. This global E.N.T. procedure is known as "Chimney Sweep". The author demonstrates that tongue behavior is severely affected by rhinopharyngeal obstruction and by the consecutive dysfunction of the upper airway ventilation pattern. Large tongues and normal tongues pushed forward due to enlarged tonsils or adenoïds are also affected by their necessary participation to oral ventilation (mouth breathers). Addition of a selective lingual glossoplasty or a partial glossectomy is sometimes necessary to put the morphogenic function in a proper order during growth and development. All of the above is part of a new pre-orthognathic concept, that helps control growth and development and helps manage orthodontic or orthognathic treatments.

Topics: Adenoidectomy; Airway Obstruction; Child; Craniofacial Abnormalities; Endoscopy; Female; Follow-Up Studies; Glossectomy; Humans; Male; Maxillofacial Development; Mouth; Mouth Breathing; Nasopharyngeal Diseases; Nose; Orthodontics, Corrective; Pulmonary Ventilation; Tongue Habits; Tonsillectomy; Turbinates

The purpose of our study was to introduce an ultrafast MR imaging technique of the pharynx as a diagnostic tool for viewing the mechanism of obstruction in patients with obstructive sleep apnea.. Six healthy volunteers and 16 patients with obstructive sleep apnea were examined on a 1.5-T whole-body imager using a circular polarized head coil. Ultrafast two-dimensional fast low-angle shot sequences were obtained in midsagittal and axial projections during transnasal shallow respiration at rest, during simulation of snoring, and during performance of the Müller maneuver. All patients underwent physical examination, transnasal fiberoptic endoscopy, and polysomnography.. Five to six images were obtained per second with an in-plane resolution of 2.67 x 1.8 mm and 2.68 x 2.34 mm, allowing visualization of motion of the tongue, soft palate, uvula, and posterior pharyngeal surface. MR findings correlated well with results of clinical examination. The length of obstruction in the oropharynx, which cannot be ascertained by transnasal endoscopy of the pharynx, was clearly visible MR images. Differences between patients with obstructive sleep apnea and healthy subjects in terms of the degree of obstruction in the velopharynx and oropharynx depicted on MR images during the Müller maneuver were highly significant.. We believe that ultrafast MR imaging is a reliable noninvasive method for use in the evaluation of obstructive sleep apnea.

Topics: Airway Obstruction; Endoscopy; Evaluation Studies as Topic; Fluoroscopy; Humans; Image Enhancement; Inhalation; Magnetic Resonance Imaging; Middle Aged; Nose; Oropharynx; Palate, Soft; Pharynx; Physical Examination; Polysomnography; Reproducibility of Results; Respiration; Rest; Sleep Apnea Syndromes; Snoring; Tongue; Uvula

Esophageal pressure amplitude (DeltaPes), inspiratory pulmonary resistance (RLI) and inspiratory flow limitation score (FS) are used as indices of upper airway obstruction for the titration of nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnea syndrome (OSAS). This study was designed to determine whether oscillatory respiratory resistive impedance at 16 Hz (RFO) might be proposed as an alternative index. Eleven OSAS patients were studied during a night of polysomnography-controlled nCPAP titration. Nasal flow (V) and airway opening and esophageal pressures (Pao and Pes, respectively) were continuously measured during nasal breathing, and forced-flow oscillations (FO) were applied for 5 min at each nCPAP level. RLI was calculated by linear regression analysis of resistive pressure versus V over inspiration. R FO was obtained by linear regression analysis of respiratory resistive impedance versus frequency. Application of FO affected neither sleep nor pulmonary mechanics. RFO correlated with RLI in all patients. RFO did not correlate with DeltaPes in two patients, and was not significantly related to FS in five patients. This study demonstrates the applicability of the FO technique in sleeping patients receiving nCPAP, and the reliability of RFO for assessing pulmonary resistance. RFO might therefore be proposed as a quantitative index of airway obstruction for nCPAP titration.

Topics: Aged; Airway Obstruction; Airway Resistance; Analysis of Variance; Esophagus; Humans; Inspiratory Capacity; Linear Models; Lung; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Reproducibility of Results; Respiration; Respiratory Mechanics; Sleep Apnea Syndromes

Since the final common pathway for obstructive sleep apnea is obstruction of the upper airway during nocturnal respiration, examination and assessment of the anatomy of the upper airway plays a central role in patient evaluation. Since the upper airway begins at the nose and lips and ends at the larynx, a complete assessment of the upper airway evaluates this entire length of this anatomic region including the bony framework and soft tissue. Though office assessment of these structures does not necessarily mimic the appearance of behavior of these structures during physiologic sleep, the office examination can give important information as to the site of obstruction during sleep that can help direct therapy.

Topics: Airway Obstruction; Body Mass Index; Endoscopy; Facial Bones; Humans; Larynx; Lip; Mouth; Neck; Nose; Oropharynx; Pharynx; Physical Examination; Pulmonary Ventilation; Sleep Apnea Syndromes

The purpose of this study was to assess the nasal volume and the cross-sectional areas of the nose in 7 to 12 year old children, and to identify factors that may influence those parameters. Specifically we investigated the effect of passive smoking at home, body mass, presence of allergies, and history of removal of the tonsils, controlling for the age, gender and race of the child. Fifty-four children participated in the study. Five consecutive nasal measurements were taken from each nostril in one visit, using the acoustic reflection technique (acoustic rhinometry). The nasal volume and the cross-sectional area were computed from the nasal readings. We observed that the minimal cross sectional area is located at the laminal valve, which has been considered one of the main anatomical structures that affect the regulation of breathing in the anterior part of the nose. We also concluded that body mass and exposure to environmental tobacco by-products play a significant role in determining reductions in a child's nasal volume. The clinical significance of such a finding and its effect to the normal craniofacial development of a growing child may force parents to reconsider smoking while at home.

Topics: Airway Obstruction; Body Constitution; Child; Female; Humans; Linear Models; Male; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Risk Factors; Tobacco Smoke Pollution

Topics: Adult; Airway Obstruction; Female; Humans; Magnetic Resonance Imaging; Male; Nose; Positive-Pressure Respiration

Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Cervical Vertebrae; Humans; Hyoid Bone; Hypopharynx; Male; Malocclusion; Mandible; Mouth; Neck; Nose; Obesity; Oxygen; Pharynx; Posture; Sella Turcica; Skull; Sleep Apnea Syndromes; Supine Position; Vertical Dimension

Conservative surgical technique (Partial inferior turbinoplasty) for enlarged inferior turbinates, not responding to adequate local and systemic therapy is described. Short and long term results are evaluated. Relief of nasal obstruction is reported in 94.7% of the patients. There is a good correlation between this success-rate and the objective measurements of the nasal resistance by active anterior rhinomanometry. Rhinorrhea or postnasal drip was still present in 34.2%. Atrophic changes in the nasal mucosa were not observed. Early post-operative epistaxis was found in 5.3% of the patients. Late post-operative epistaxis did not occur.

Topics: Adolescent; Adult; Aged; Airway Obstruction; Child; Female; Follow-Up Studies; Humans; Male; Manometry; Middle Aged; Nose; Premedication; Surgical Procedures, Operative; Turbinates

Our study was to assess whether there were differential effects of nasal continuous positive airway pressure (nCPAP) on different kinds of obstruction in either upper or lower airways in patients with chronic obstructive pulmonary disease (COPD). nCPAP (6 cmH2O for ten minutes) was applied to 7 patients with reversible extrathoracic upper airway obstruction (RUAO) and 3 patients with fixed extrathoracic upper airway obstruction (FUAO). Eighteen stable asthmatics, receiving methacholine challenge to induce a more than 20% reduction in FEV1, were randomly investigated for the effect of nCPAP or sham pressure on reversible lower airway obstruction. Nine stable COPD patients were enrolled to study the effect on irreversible lower airway obstruction. Maximal expiratory and inspiratory flow volume curves and dyspnoea scores were obtained before and after immediate withdrawal of nCPAP. In the RUAO group, nCPAP significantly improved stridor and dyspnoea scores, decreased the ratio of FEF50/FIF50 from 2.05 +/- 0.25 to 1.42 +/- 0.16, and increased peak inspiratory flow (PIF) as well as forced inspiratory vital capacity by 26 +/- 8% and 9 +/- 4%, respectively. In expiratory phase, there was no significant change in pulmonary functions. In asthmatics, nCPAP significantly reversed methacholine-induced bronchoconstriction increasing forced vital capacity by 10 +/- 3%, FEV1 by 15 +/- 4% and PIF by 32 +/- 11%. nCPAP significantly increased the response to bronchodilators. The improvement in airflow rate persisted for at least 5 min after nCPAP withdrawal and was highly correlated with the response to bronchodilators. There was no significant effect of nCPAP on airflow rate in COPD patients. Subjective dyspnoea score changes paralleled the pulmonary function improvement. We conclude that there are differential effects of nCPAP on airflow rates in patients with different nature of airway obstruction. Patients with airway obstruction caused by structural changes may not benefit from the use of nCPAP in improving airflow rates.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Asthma; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nasal Obstruction; Nose; Positive-Pressure Respiration; Respiratory Function Tests; Treatment Outcome

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Topics: Adult; Airway Obstruction; Cadaver; Dissection; Drainage; Endoscopy; Feasibility Studies; Female; Follow-Up Studies; Frontal Sinus; Frontal Sinusitis; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Septum; Nose; Recurrence; Tomography, X-Ray Computed

This is a retrospective review of children 15 years of age or younger, who underwent overnight sleep studies between 1980 and 1993. All were diagnosed and treated for obstructive sleep apnea (OSA). Overnight studies were performed for OSA in 413 children. One hundred seventy-five (42.4%) children were treated with adenotonsillectomy and 80 (19.4%) with nasal mask continuous positive airway pressure (nCPAP). The proportion of male children was greater than expected in both the entire study group (69%, p < 0.001) and in those treated with nCPAP for OSA (71% p < 0.001). There was no significant difference between the mean age of the children treated with nCPAP (5.7 +/- 0.5 yr) and the entire group studied (5.04 +/- 0.21 yr). A greater proportion of the children who received nCPAP therapy had a congenital syndrome or malformation than in the group with OSA as a whole; 27.7% of children assessed for OSA were affected, and 53% of those children with OSA who received treatment with nCPAP (p < 0.001). Therapy with nCPAP (mean duration 15 +/- 3 mo, mean pressure 7.9 cm H2O) eliminated the signs of OSA in 72 children (90%). Respiratory disturbance index fell from a mean of 27.3 +/- 20.2 to 2.55 +/- 2.74 (p < 0.001). Eight of 32 children who underwent pressure determination studies could not tolerate nCPAP above an upper limit because of hypoventilation or frequent central apneas. Nevertheless, we conclude that nCPAP is an effective and generally well-tolerated therapy for treatment of OSA in infants and children.

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Infant; Male; Masks; Nose; Polysomnography; Positive-Pressure Respiration; Pulmonary Ventilation; Respiratory Insufficiency; Retrospective Studies; Sleep Apnea Syndromes; Sleep Stages; Tonsillectomy; Treatment Outcome

Twenty-one patients were examined, of whom 18 suffered from obstructive sleep apnea syndrome and 3 were heavy snorers. The diagnosis was established by a combination of medical history, clinical examination and standard nocturnal polysomnography. Five pressure transducers were used in the pharynx and one in the esophagus, in addition to monitors for oxygen saturation and oro-nasal airflow. A clinically significant obstruction was defined as occurring when the pressure difference between two transducers was higher than 50% of the more caudal of the two pressures. In the 20 patients having obstructions during sleep, 7 had obstruction in only one segment of the airway, 9 in two segments and 4 in three segments. All but 2 patients had obstructions in the velopharyngeal region. Since the effect of uvulopalatopharyngoplasty (UPPP) is best during the first few months after surgery, 10 patients were re-examined after only 3 months in order to record optimal results sequentially. Of these, 6 still had obstructions involving the velopalatine segments and only 4 had none. This may explain why UPPP has a success rate of only 50-70% in most publications, depending on the definitions of success.

Topics: Airway Obstruction; Airway Resistance; Esophagus; Follow-Up Studies; Humans; Mouth; Nose; Oxygen Consumption; Palate, Soft; Pharynx; Polysomnography; Pressure; Pulmonary Ventilation; Sleep; Sleep Apnea Syndromes; Snoring; Transducers, Pressure; Uvula

To determine the mechanism for obstructive sleep apnea in two patients with clinical abnormalities of laryngeal function, airflow dynamics during sleep were analyzed. The site of airway obstruction was assessed by examining pressure gradients across specific airway segments. The relation between maximal inspiratory airflow and nasal pressure was analyzed to determine (1) the critical pressure, a measure of the collapsibility of the laryngeal airway, and (2) the effect of nasal continuous positive airway pressure on airflow during sleep. Large inspiratory pressure gradients developed during sleep between the supraglottic and pleural spaces, indicating that collapse had occurred in the larynx. Elevated critical pressures of -6.4 and +1.2 cm H2O, respectively, occurred in the two patients. When the nasal pressure was raised to 10 cm H2O, normal levels of tidal airflow occurred, and obstructive apneas were eliminated. These findings indicate that sleep apnea was caused by laryngeal airflow obstruction that resulted from elevations in the collapsibility of the larynx. The response to nasal continuous positive airway pressure suggested that laryngeal sleep apnea was similar to pharyngeal sleep apnea in pathophysiologic characteristic and response to treatment.

Topics: Adult; Airway Obstruction; Arnold-Chiari Malformation; Humans; Inhalation; Laryngeal Diseases; Male; Middle Aged; Nose; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Respiratory Sounds; Shy-Drager Syndrome; Sleep Apnea Syndromes; Sleep Stages; Tidal Volume

Nasal continuous positive airways pressure (nCPAP) is recommended in children for the treatment of obstructive sleep apnoea which persists following adenotonsillectomy. Nasal CPAP was successfully used in the palliative care of two severely disabled children with upper airway obstruction as an alternative to tracheostomy. Nasal CPAP resulted in the correction of obstructive apnoea in sleep, with the added benefit of sleep consolidation and fewer nocturnal arousals requiring parental attendance. There was also an unexpected benefit of reduced airway problems in the awake state in these children. Nasal CPAP is an effective form of treating upper airway obstruction for palliative care in association with other major disabilities.

Topics: Airway Obstruction; Child, Preschool; Female; Humans; Infant; Nose; Palliative Care; Positive-Pressure Respiration; Respiratory Insufficiency; Tracheostomy

The ability to switch from nasal to oral breathing in response to nasal obstruction is crucial for survival, and has been suggested to be an important mechanism in preventing sudden infant death syndrome (SIDS). To know whether the ability to switch from nasal to oral breathing is uniformly present during the early neonatal period, we examined the effects of slow and fast nasal occlusions on the establishment of oral breathing in preterm infants. Slow occlusions were used to mimic more closely occlusions occurring spontaneously. We studied 17 healthy preterm infants [birth weight, 1830 +/- 27 g (mean +/- SE); study weight, 1800 +/- 109 g; gestational age, 32 +/- 1 weeks; postnatal age, 12 +/- 2 days]. We used a nosepiece with a nasal occluder and a flow-through system to measure ventilation. A CO2 sampling catheter at the mouth was used to detect oral breathing. Of 58 occlusions, 29 were slow [resistance increasing slowly from 0 to infinite (occlusion)], and 29 were fast (infinite elastance applied in < 1 sec). Oral breathing was always established following slow and fast occlusions. In 44% of the slow occlusions, oral breathing started before complete occlusion. Arousal was observed in 12/58 (17%) of all occlusions, occurring primarily after initiation of oral breathing. Oxygen saturation and respiratory rate decreased significantly following occlusions, from 96 +/- 0.6 to 87 +/- 1.2% and 49 +/- 2.8 to 38 +/- 2 breaths/min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Airway Obstruction; Female; Humans; Infant, Newborn; Infant, Premature; Male; Mouth Breathing; Nose; Sudden Infant Death; Time Factors

Topics: Airway Obstruction; Aneurysm, Infected; Carotid Artery Diseases; Carotid Artery, Common; Equipment Design; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose

This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring.

Topics: Adult; Aged; Airway Obstruction; Dilatation; Equipment Design; Female; Humans; Male; Middle Aged; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages; Snoring

Continuous negative airway pressure (CNAP) causes a decrease in lung volume, which is known to increase upper airway resistance by itself. We studied how this lung volume change could modify upper airway collapsibility with five normal awake subjects. In a first trial, pressure in a nasal mask (Pm) was progressively decreased in 3- to 5-cmH2O steps (CNAP). In a second trial, changes in lung volumes resulting from CNAP were prevented by applying simultaneously an equivalent level of negative extrathoracic pressure into a poncho-type respirator [isovolumetric CNAP (CNAPisovol)]. For each trial, we examined the relationship between the maximal inspiratory airflow of each flow-limited inspiratory cycle and the corresponding Pm by least-squares linear regression analysis and determined the critical pressure. We also determined the Pm threshold corresponding to the first Pm value below which flow limitation occurred. Flow limitation was observed in each subject with CNAP but in only two subjects with CNAPisovol. In these two subjects, the Pm threshold values were -20 and -9 cmH2O with CNAP and -39 and -16 cmH2O with CNAPisovol, respectively. Critical pressures for the same two subjects were -161 and -96 cmH2O with CNAP and -202 and -197 cmH2O with CNAPisovol, respectively. We conclude that CNAP-induced decreases in lung volume increase upper airway collapsibility.

Topics: Adult; Airway Obstruction; Differential Threshold; Female; Humans; Inspiratory Capacity; Lung; Male; Masks; Nose; Pressure; Pulmonary Ventilation; Regression Analysis; Ventilators, Negative-Pressure

Topics: Airway Obstruction; Female; Forensic Medicine; Humans; Nose

Topics: Airway Obstruction; Female; Humans; Middle Aged; Nose; Positive-Pressure Respiration; Ventilators, Mechanical

Topics: Adult; Airway Obstruction; Female; Humans; Intubation, Intratracheal; Male; Mediastinal Emphysema; Middle Aged; Nose; Orthognathic Surgical Procedures; Subcutaneous Emphysema; Turbinates

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.

Topics: Airway Obstruction; Endoscopy; Humans; Hypopharynx; Nose; Oropharynx; Palate, Soft; Pharynx; Respiration; Sleep Apnea Syndromes; Snoring

The static and dynamic aspects of nasal anatomy determine the characteristics of the air flow passing through the nose and the thermo-hygrometric and particulated conditioning of the inhaled air. Through rhinomanometry it is possible to measure nasal cavities resistance to the passage of inhaled and exhaled air. Ventilation obstacles in the nose are frequent and varied: they are examined with the consequences of nasal obstruction at local and zonal level.

Topics: Airway Obstruction; Airway Resistance; Humans; Manometry; Nasal Cavity; Nasal Septum; Nose; Respiration; Rhinitis

This report describes the polysomnographic findings and the respiratory alterations during sleep in a 20-year-old patient with the Prader-Willi syndrome. Nocturnal recordings and a variant of the multiple sleep latency test showed excessive daytime sleepiness, sleep onset rapid eye movement episodes, snoring and sleep apnea. Treatment with nasal continuous positive airway pressure normalized the respiratory pattern and the sleep structure, except for rapid eye movement sleep onset. Whereas upper airway obstruction and obesity may explain the respiratory disorders, as shown by their resolution with continuous positive airway pressure treatment, hypothalamic dysfunction could play a role in the disruption of the normal nonrapid eye movement/rapid eye movement sleep periodicity.

Topics: Adult; Airway Obstruction; Heart Rate; Humans; Hypothalamus; Male; Nose; Positive-Pressure Respiration; Prader-Willi Syndrome; Sleep Apnea Syndromes; Sleep Wake Disorders; Sleep, REM; Snoring

Methylene blue was placed in the pharynx of 64 patients undergoing anaesthesia with the laryngeal mask. No leak of dye into the larynx was detected on fibreoptic inspection of the inside of the mask in any subject. The use of the laryngeal mask as a means of protecting the airway during procedures such as minor nasal operations is therefore supported.

Topics: Airway Obstruction; Anesthesia, Inhalation; Female; Humans; Intubation; Larynx; Male; Masks; Methylene Blue; Nose; Pharynx

The airway vascular and bronchial responses were studied in pigs sensitized with Ascaris suum. Ascaris, histamine (H) and capsaicin aerosol all induced a clear-cut increase in blood flow in the nasal, laryngeal and bronchial circulation with a decrease in vascular resistance of 20-40%. When delivered to the lung both ascaris and histamine, but not capsaicin, caused pulmonary airflow obstruction with increase in resistance and a fall in dynamic compliance of 40-70%. After pretreatment of pigs with a combination of the H1- and H2-receptor antagonists terfenadine and cimetidine, the vascular and bronchial responses were strongly reduced to both histamine (by greater than 77%) and ascaris (by greater than 58%), but not to capsaicin aerosol. The bronchoconstriction to histamine was found to be mediated by H1-receptors only, while both H1- and H2-antagonists were necessary to block the vasodilatory response, with H2-receptors being more important in the bronchial circulation and H1-receptors being more important in the laryngeal and nasal circulation. Furthermore, when pigs were pretreated with capsaicin systemically 2 days before the experiment, the vasodilation was decreased upon capsaicin (by 80%), ascaris (by greater than 40%) and histamine (by greater than 50%) aerosol challenge. When histamine was administered intravenously the desensitizing effect of capsaicin pretreatment was much less pronounced. The effect of capsaicin desensitization on the pulmonary obstruction upon ascaris and histamine challenge was limited to a 60% reduction of the fall in dynamic compliance and a delayed peak in resistance upon ascaris challenge. We conclude that histamine is one of the main vasodilatory mediators released upon allergen challenge at three different levels of the pig airways. A considerable part of the histamine effect is indirect and probably due to activation of capsaicin-sensitive sensory nerves.

Topics: Airway Obstruction; Animals; Antigens, Helminth; Ascaris; Bronchi; Capsaicin; Histamine; Larynx; Nose; Swine; Vascular Resistance

Total inferior turbinectomy was carried out in 38 patients who complained of nasal obstruction following rhinoplasty or rhinoseptoplasty and in whom hypertrophied inferior turbinates were found to be the cause of obstruction. Postoperatively, relief of nasal obstruction was reported by 84 percent of patients, while rhinoscopy showed wide, clean nasal airways in 92 percent. Nasal airflow measurements in 32 tested patients showed increased patency in all of them, including 3 who still complained of nasal obstruction postoperatively. The follow-up period ranged from 1 to 7 years (mean 2.8 years). Atrophic changes of the nasal mucosa or chronic purulent infection was not observed in any of the patients. Because the results of partial procedures on the inferior turbinates are often unsatisfactory, I suggest performing total inferior turbinectomy in patients with obstructing inferior turbinates following rhinoplasty.

Topics: Adolescent; Adult; Airway Obstruction; Female; Follow-Up Studies; Humans; Hypertrophy; Male; Nasal Septum; Nose; Nose Diseases; Postoperative Complications; Pulmonary Ventilation; Rhinoplasty; Tissue Adhesions; Turbinates

Nasal resistances were measured before and after decongestion of the nasal mucosa by posterior rhinomanometry with a head-out body plethysmograph in 95 adults referred to our nasal airflow laboratory. These resistances were calculated by a time averaging method (1), the equation R = delta P/V at delta P 1.0 cm H2O (2) and R = delta P/V at the point of peak flow (3), and the results were compared. Correspondence between resistances from the time averaging method and those from the equation R = delta P/V at delta 1.0 cm H2O, the equation R = delta P/0.83V1.33 was obtained with statistical significance (P less than 0.001) and it is suggested that the value of resistance from the time averaging method represents transitional airflow. At resistances less than 3.5 cm H2O/L/sec, the time averaging method and the equation R = delta P/V at delta 1.0 cm H2O and at peak flow produced almost identical values. At resistances greater than 3.5 cm H2O/L/sec, the time averaging method produced values equivalent to those from the equation R = delta P/V at peak flow but values from the equation R = delta P/V at delta P 1.0 cm H2O different from the former two methods. The results suggest that nasal resistances from the time averaging method and the equation R = delta P/V at the point of peak flow are appropriate expression of nasal patency.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Computers; Female; Humans; Male; Manometry; Middle Aged; Nasal Decongestants; Nose; Plethysmography

In this retrospective study we used active, anterior mask rhinomanometric methods to measure nasal resistance before and after surgery for nasal obstruction. The study group comprised 60 patients with nasal obstruction who had 63 preoperative and postoperative rhinomanograms and the control group contained 14 asymptomatic patients who underwent rhinomanometric studies before transnasal, transsphenoidal pituitary surgery. Before surgery the study group had significantly higher total and combined unilateral nasal resistances than either the control group before surgery (p less than 0.05 and p less than 0.01, respectively) or the study group after surgery (p less than 0.0001 for both comparisons). Surgery normalized the nasal resistances of the study group in relation to the control group. A total nasal resistance greater than 1 cm H2O/L/sec or a unilateral resistance greater than 3.5 cm H2O/L/sec suggests clinically significant nasal obstruction. Airway narrowing and obstructive symptoms correlated with airway resistance in the preoperative patient, but symptoms did not correlate well with postoperative resistance.

Topics: Adolescent; Adult; Aged; Airway Obstruction; Airway Resistance; Child; Humans; Manometry; Middle Aged; Nose; Postoperative Care; Preoperative Care; Retrospective Studies

Nasal obstruction is a cause of disordered breathing during sleep. Our previous study demonstrated diminished end-tidal PCO2 with nose obstruction while subjects were awake. If this is also the cause during sleep, decreased CO2 stimulus may easily induce apnea, hypopnea, and disordered breathing. To test this hypothesis, six male volunteers were examined to compare sleep disorders during both nose-open and nose-obstructed conditions. End-tidal PCO2 during nose-obstructed sleep was lower than that during nose-open sleep in all of the subjects. Furthermore apnea during nasal obstruction occurred most frequently shortly after transition to a deeper sleep stage. These results suggest that diminished PCO2 stimulus combined with depressed behavioral activity play an important role for disordered breathing in nose-obstructed sleep.

Topics: Adult; Airway Obstruction; Carbon Dioxide; Humans; Male; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages

Plasma concentrations of a stable prostaglandin F2 alpha metabolite were measured by radioimmunoassay during and after recovery from acute airway obstruction in 15 infants. Mean (SEM) metabolite concentrations (ng/l) in plasma obtained both before (1033 (418)) and after (1470 (413)) initial treatment for airway obstruction were significantly higher than those obtained from the same subjects after resolution of the obstruction--25.5 (6.6)--and those obtained from two comparison groups. Infants positive for respiratory syncytial virus (mean 1122 (227)) had significantly higher concentrations than those who were negative (207.6 (46)). Additionally, seven subjects with a history of recurrent wheezing after resolution of airway obstruction had a significantly higher mean level (3500 (1400)) during attacks of airway obstruction than those without (600 (100)). These data suggest that prostaglandin F2 alpha mediates respiratory inflammation in airway obstruction and that trials of specific anti-inflammatory agents for the treatment of airway obstruction may be warranted.

Topics: Airway Obstruction; Dinoprost; Humans; Infant; Nose; Respiratory Sounds; Respiratory Syncytial Viruses

The controversy regarding nasal obstruction and malocclusion has been largely due to the inability to quantitate nasal airway function and hence objectively determine the mode of breathing. The purpose of this study was to measure the nasal airway resistance of patients before and after rapid maxillary expansion (RME), to compare them to a control group of subjects not receiving RME, and to measure oral/nasal airflow ratios (respiratory mode). An evaluation of the statistical associations between anterior facial height, lip posture, oral/nasal airflow ratios, and nasal resistance was undertaken. The effects of RME on nasal resistance have been reported elsewhere. We found that variation, for resistance values, was very high, and thus the median response for the group was not an adequate estimation of individual response. In this paper we describe associations between lip posture, lower anterior facial height, and nasal resistance. No significant correlations could be established between respiratory and morphologic features. Lower anterior facial height was greater in the lips apart posture group. However, there was no significant correlation between percent nasality and lower anterior facial height. A small negative correlation (r = -0.47) existed between nasal resistance and percent nasality, but this relationship was not linear. Thus, it was not possible to predict percent nasality from nasal resistance data. Furthermore, no correlation was found between the amount of expansion and changes in nasal resistance. This paper was originally submitted June 1986, and revised October 1988.

Topics: Adolescent; Airway Obstruction; Airway Resistance; Cephalometry; Child; Dental Arch; Face; Humans; Lip; Manometry; Mouth Breathing; Nose; Palatal Expansion Technique; Pulmonary Ventilation; Vertical Dimension

Topics: Airway Obstruction; Face; Humans; Nose; Otolaryngology

Our aim was to determine the effects of pharmacological sedation on oral breathing induced by nasal obstruction in chronically prepared newborn and mature sheep. Nasal obstruction (5 min) was achieved by blocking tubes temporarily fixed into the nostrils. We continuously recorded EMG activity of the diaphragm, genioglossus and digastric muscles, intrapleural pressure and percent O2 saturation in arterial blood (SaO2). Blood samples were taken intermittently and analysed for SaO2, P02, PCO2 and pH. As previously reported, nasal obstruction in lambs and ewes led to asphyxial changes in blood gases and pH; lambs were affected more than ewes. Respiratory responses to nasal obstruction were retested after administration of pentobarbitone Na (5 and 10 mg/kg), diazepam (0.2 and 0.4 mg/kg) and alcohol (nominally 0.075 and 0.11% of blood w/v). Pentobarbitone and diazepam, both of which produced sedation, delayed the onset of oral breathing and led to a greater degree of asphyxia during nasal obstruction. EMG activities in the genioglossus and digastric muscles were inhibited by the drugs, whereas the depth of inspiratory efforts was not. Alcohol had no apparent sedative effect, nor did it significantly affect responses to nasal occlusion. We conclude that sedating doses of pentobarbitone and diazepam depress the effectiveness of oral breathing when the nose is blocked, probably owing to their inhibitory effects on activation of muscles maintaining patency of an oral airway.

Topics: Airway Obstruction; Animals; Animals, Newborn; Behavior, Animal; Blood Gas Analysis; Diazepam; Ethanol; Female; Mouth Breathing; Nose; Pentobarbital; Respiration; Respiratory Muscles; Sheep

A five-year follow-up study was performed on 26 children treated for nasal obstruction by adenoidectomy, who exhibited a changed mode of breathing postoperatively. They were compared with a control group matched according to age and sex. Lateral skull radiographs were used to examine mandibular morphology. The mandibular outline was registered using 36 digitized points. This method of portraying growth changes provides a valuable complement to isolated measurements. The technique revealed a more anterior direction of symphyseal growth in the adenoidectomy group following surgery as well as some reversal of the initial tendency to a posterior rotation of the mandible.

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Cephalometry; Child; Face; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Mandible; Mouth Breathing; Nose; Radiography; Respiration

Posterior rhinometric measurements of nasal resistance were conducted on two groups of patients with perennial rhinitis: those whose symptom of nasal stuffiness responded to a topical steroid spray and those in whom it did not. The anterior ends of the inferior turbinates in 48 patients were treated with either cryosurgery or cautery, and in half of the subjects the erectile tissue of the septum was also thermally ablated. Measurements were made before and 10-16 weeks after therapy. It is concluded from statistical comparison that there is no benefit to treating the septum, and that cryosurgery is more effective in those whose symptoms respond to topical steroids, while cautery works better in those who do not. Histology showed no change in the capacitance vessels (sinusoids) after either modality, and xylometazoline caused a marked decrease in nasal resistance, suggesting that vascular smooth muscle function was intact. Irrespective of the change in airway resistance, most subjects felt that there had been an improvement. The mechanism is discussed.

Topics: Adult; Airway Obstruction; Airway Resistance; Beclomethasone; Cryosurgery; Electrocoagulation; Female; Humans; Male; Manometry; Nasal Septum; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Perennial; Turbinates

We report two cases of massive invasive pituitary adenoma with the unusual presentation of nasal obstruction. In both cases the diagnosis was only made when the obstructing tissue was removed. Cases reported previously have usually presented with severe focal neurological signs or a long history of neurological symptoms. These two cases are unusual in having minimal neurological deficits despite the extension of tumour into the nasopharynx and the middle and posterior cranial fossae. These extensions were well illustrated by computerised tomography. This unusual presentation is discussed with reference to the literature.

Topics: Adenoma, Chromophobe; Adult; Airway Obstruction; Apudoma; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Nose; Pituitary Neoplasms; Tomography, X-Ray Computed

Airway patency following repair for choanal atresia is effectively maintained utilizing Argyle polyethylene chest tubes as stents. Retrograde placement of the tubes from the mouth into the nasal passage is accomplished so that once secured, the largest diameter of the tubes is wedged against the posterior portion of the nasal ostium. This approach limits anterior migration of the tubes, preserving the columella and nasal rims while ensuring maintenance of airway patency following treatment of choanal atresia.

Topics: Airway Obstruction; Catheterization; Humans; Nose; Prostheses and Implants

We measured differential pressure and airflow at constant flow through a cylinder which had a variable aperture in its central portion, by means of a Rhinorheograph MPR-1100 in order to obtain a turbulent coefficient "n" experimentally in the equation R = delta P/Vn. Between of 1.0-5.0 cm H2O (not equal to 100-500 Pa) pressure, the coefficient "n" was distributed between 1.01-2.80 with a mean value of 2.02 (+/- 0.36), and resistances calculated from the equation R = delta P/Vn were almost the same value at each differential pressure. We applied this coefficient to 95 adult patients referred to our nasal airflow laboratory in Toronto, and found the equation R = delta P/V2 to be quite suitable for clinical assessment.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Female; Humans; Male; Manometry; Middle Aged; Nose; Nose Diseases; Pulmonary Ventilation; Regression Analysis

Nasal respiration may be assessed as part of the diagnosis and management of persons with orofacial growth disturbances. It is often evaluated by calculating nasal airway resistance. Traditional methods for measuring nasal airway resistance do not provide information about nasal cavity versus velopharyngeal resistance components. A method that partitions nasal airway resistance into its nasal cavity and velopharyngeal components would provide a localized measurement of airway obstruction useful in evaluating the effects of surgical reconstruction of the velopharynx, enlarged adenoids, adenoidectomy, and nasal cavity obstructions along the nasal airway. A modeling project is presented delineating a method for partitioning nasal airway resistance into its nasal cavity and velopharyngeal components.

Topics: Airway Obstruction; Airway Resistance; Humans; Models, Biological; Nasal Cavity; Nose; Nose Diseases; Palate, Soft; Pharyngeal Diseases; Pharynx; Pressure; Pulmonary Ventilation

Topics: Airway Obstruction; Airway Resistance; Child; Humans; Malocclusion; Mouth Breathing; Nose; Respiration

The purpose of this study was to determine the respective oral and nasal contributions to total respiration in patients scheduled for surgical corrections of nasal obstruction. The effect of anterior nares expansion and/or nasal decongestant administration on the nasal component of breathing was also examined in these patients. Although variability among subjects was demonstrated in the ratio of nasal respiration to total respiration, 25% of the "nasally-obstructed" patients were 100% nasal breathers and no patient had a nasal component less than 18% of total respiration. Great variability existed among the patients in their response to nares expansion and/or decongestant administration. Collectively, they demonstrated no significant mean increase in nasal respiration with nares expansion alone. The patients demonstrated an increase with administration of the decongestant and with decongestant combined with nares expansion. The latter condition resulted in an increase that was greater than with decongestant alone. The implication of this study is that the traditional diagnostic terms "mouth breathing" or "nasal obstruction" are not useful. They do not describe the type, location, or severity of an obstruction or the relative contribution of the nose and mouth to respiration. Many patients who experience symptoms or have signs of nasal obstruction can functionally compensate to maintain 100% nasal breathing.

Topics: Adult; Airway Obstruction; Female; Humans; Male; Mouth; Mouth Breathing; Nasal Decongestants; Nose; Nose Diseases; Pulmonary Ventilation; Respiration

Topics: Airway Obstruction; Humans; Lung Volume Measurements; Mouth; Nose; Oxygen

Topics: Airway Obstruction; Enteral Nutrition; Equipment Design; Female; Humans; Infant, Newborn; Infant, Premature; Intubation; Nose

Most clinicians agree that impaired nasal breathing results in obligatory mouth breathing. Some believe that mouth breathing influences dentofacial growth; others disagree. The term mouth breathing is confusing because total mouth breathing rarely occurs. A combination of nasal and oral breathing is more usual. The purpose of the present study involving 116 adult subjects was to (1) assess the relationship between nasal impairment and nasal-oral breathing, (2) determine the switching range from nasal to nasal-oral breathing, and (3) quantify the term mouth breathing. The pressure-flow technique was used to estimate nasal airway size; inductive plethysmography was used to assess nasal-oral breathing in normal and impaired breathers. Analysis of the date showed a Pearson rank correlation of 0.545 (P less than 0.001) between nasal area and nasal-oral respiration. Ninety-seven percent of subjects with a nasal size less than 0.4 cm2 were mouth breathers to some extent. About 12% of subjects with an adequate airway were assumed to be habitual mouth breathers. The findings indicate that the switching range from nasal to nasal-oral breathing is very narrow (0.4-0.45 cm2). These results also confirm our contention that in adults an airway less than 0.4 cm2 is impaired.

Topics: Adult; Airway Obstruction; Humans; Mouth Breathing; Nose; Pressure; Pulmonary Ventilation; Respiration; Rheology

40 children of both sexes, aged 5-12, with deviations or fractures of the nasal septum were tested. These children were selected for septoplasty on the basis of anamnestic data, ENT examination and anterior rhinomanometry with and without anamnestic data. The control group consisted of 15 children, of approx. the same age and sex distribution, with normal nose breathing and rhinomanometrical findings. The operated group underwent clinical and rhinomanometrical examination 3 and 12 months after surgery, and the control group 12 months after the initial examination. Septoplasty was performed under general anaesthesia with locally applied vasoconstrictors. The results showed that rhinomanometrical resistances prior to surgery were significantly higher in all the subjects in the operated group than those in the control group. Rhinomanometrical resistances were lower in 29 operated cases 3 months after septoplasty than before septoplasty, and significantly lower in 32 operated cases 12 months after septoplasty. Rhinomanometrical resistances in the operated group 12 months after surgery were a little higher than those in the control group 12 months after the initial examination. Failures and complications after septoplasty are commented upon, as is their influence on rhinomanometrical resistances.

Topics: Airway Obstruction; Airway Resistance; Child; Child, Preschool; Endoscopy; Female; Fractures, Cartilage; Humans; Male; Manometry; Nasal Septum; Nose; Nose Diseases; Respiration

The hypothesis tested in these experiments was that factors other than contraction of upper airway muscles influence the resistance of the upper airway to collapse. The intra-luminal pressures required to close and re-open the upper airway were measured in the isolated upper airways of anesthetised rabbits. The level of activity in upper airway muscles manipulated by ventilation with 100% O2 or 7% CO2 and by muscle paralysis with gallamine. During ventilation with 100% O2 closing pressure was -10.34 +/- 0.53 cm H2O (mean +/- 95% c.i., n = 23) and re-opening pressure was -3.15 +/- 0.51 cm H2O. Ventilation with 7% CO2 changed the closing pressure to -11.63 +/- 0.67 cm H2O (P less than 0.05) and re-opening pressure to -3.81 +/- 0.67 cm H2O (NS). In 10 animals muscle paralysis with gallamine (2 mg/kg i.v.) did not significantly alter closing or re-opening pressures during ventilation with 100% O2, and did not abolish the ability of ventilation with 7% CO2 to augment collapse resistance. In 6 animals death was followed by a fall in closing and re-opening pressures to 30-60% of the values recorded in paralysed animals. We conclude that in this preparation active muscle contraction is not the main source of resistance to airway closure or of the proclivity of the closed airway to re-open.

Topics: Airway Obstruction; Animals; Electromyography; Female; Gallamine Triethiodide; Male; Nose; Pressure; Pulmonary Ventilation; Rabbits; Respiratory Muscles; Trachea

To determine the combined effect of increased subatmospheric upper airway pressure and withdrawal of phasic volume feedback from the lung on genioglossus muscle activity, the response of this muscle to intermittent nasal airway occlusion was studied in 12 normal adult males during sleep. Nasal occlusion at end expiration was achieved by inflating balloon-tipped catheters located within the portals of a nose mask. No seal was placed over the mouth. During nose breathing in non-rapid-eye-movement (NREM) sleep, nasal airway occlusion resulted in multiple respiratory efforts before arousal. Mouth breathing was not initiated until arousal. Phasic inspiratory genioglossus activity was present in eight subjects during NREM sleep. In these subjects, comparison of peak genioglossus inspiratory activity on the first three occluded efforts to the value just before occlusion showed an increase of 4.7, 16.1, and 28.0%, respectively. The relative increases in peak genioglossus activity were very similar to respective increases in peak diaphragm activity. Arousal was associated with a large burst in genioglossus activity. During airway occlusion in rapid-eye-movement (REM) sleep, mouth breathing could occur without a change in sleep state. In general, genioglossus responses to airway occlusion in REM sleep were similar in pattern to those in NREM sleep. A relatively small reflex activation of upper airway muscles associated with a sudden increase in subatmospheric pressure in the potentially collapsible segment of the upper airway may help compromise upper airway patency during sleep.

Topics: Adult; Airway Obstruction; Diaphragm; Electromyography; Humans; Male; Mouth Breathing; Muscles; Nose; Sleep; Sleep, REM

Topics: Aged; Airway Obstruction; Ameloblastoma; Female; Humans; Male; Maxillary Neoplasms; Middle Aged; Nose

The aims of this study were to compare the ability of awake newborn lambs and adult sheep to breathe orally when the nasal route was blocked and to determine the means by which it was accomplished. Chronic EMG electrodes (diaphragm, genioglossus, geniohyoid, posterior crico-arytenoid, digastric, thyroarytenoid) and fibre-optic catheters were implanted in 10 lambs and 4 ewes. Before each study soft tubes were fixed into the nostrils allowing rapid blockade of the nasal ventilatory pathway. During nasal blockade inspiratory upper airway dilator EMG activity increased. SaO2 fell until mouth opening occurred, then returned to near control values; oral breathing then ceased leading to desaturation again. In lambs and ewes there was significant hypoxia, hypercapnia and acidaemia. In lambs 2-14 days old, PO2 and pH fell to lower levels than in older lambs (15-30 days) or ewes and PCO2 rose more. In lambs PCO2 gradually increased during the period of obstruction. We conclude that maintenance of blood gas homeostasis in newborn lambs is more severely impaired by nasal obstruction than in older lambs or ewes, possibly due to an immaturity of neural mechanisms controlling the creation of an oral airway.

Topics: Airway Obstruction; Animals; Animals, Newborn; Carbon Dioxide; Female; Homeostasis; Hydrogen-Ion Concentration; Nose; Oxygen; Respiration; Respiratory Muscles; Sheep

The controversy concerning the effects of nasal airway impairment on facial growth has stimulated renewed interest in upper airway respiratory function. The subjective manner in which airway impairment and mouth breathing have been assessed is, in our opinion, responsible for the differences observed among investigators and for their conclusions. We have been involved in a series of studies dealing with airway impairment and have report modifications of two techniques for objectively assessing respiration. The purpose of the present study was to examine a large population of adults, with and without nasal airway impairment, and assess the relationship between nasal cross-sectional area and nasal air volume to determine at what point airway size controls the passage of air during breathing. Statistical analysis of the data demonstrates that airway size alters air volume when nasal cross-sectional area is less than 0.4 cm2. The relationship between area and volume is very linear below 0.4 cm2, with air volume decreasing with decreased size. Although the data do indicate some influence over volume at sizes greater than 0.4 cm2, the effect is very slight. These findings support the prediction that upper airway impairment is present at nasal airways less than 0.4 cm2 in adults.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Humans; Nose; Pulmonary Ventilation; Respiration

Mouth breathing in response to an impaired nasal airway is thought to have clinical consequences. Physiologically, mouth breathing occurs whenever the body senses that nasal resistance is inappropriately high. In physical terms mouth breathing is a response that enlarges the upper airway and, by doing so, reduces airway resistance. In the past measurements of nasal resistance have been used as an index of airway impairment. Recently, we introduced a technique that estimates cross-sectional size of the airway, a variable that directly determines the magnitude of airway resistance. The purpose of the present study was to determine the precise effects of nasal airway size on nasal airway resistance so that the relationship between the two could be described in mathematic terms. There were two phases to the study--one involving a model and simulated breathing, and the other involving 100 subjects demonstrating normal and impaired nasal airways. The pressure-flow technique for estimation of nasal airway size and nasal airway resistance was used. The following equation was generated from the data: Resistance = 1.9 + (Formula: see text). The relationship between the two variables is nonlinear--that is, size of the airway has its greatest effect on resistance when the airway is less than 0.4 cm2 and a much lesser effect at larger airway sizes. The study also showed that nasal airway resistance generally does not fall very much below 1.9 cm H2O/L/S during breathing even when the airway is very large. This probably relates to the need to maintain an adequate level of airway resistance for alveolar gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Air Pressure; Airway Obstruction; Airway Resistance; Humans; Mathematics; Models, Biological; Mouth; Nose

Topics: Airway Obstruction; Eye, Artificial; Facial Neoplasms; Humans; Maxillofacial Prosthesis; Nose; Prosthesis Design

Topics: Airway Obstruction; Child; Craniofacial Dysostosis; Humans; Malocclusion; Nose

Topics: Airway Obstruction; Child; Craniofacial Dysostosis; Humans; Maxillofacial Development; Nose; Surgery, Plastic

Previous studies have shown that the arousal threshold to hypoxia, hypercapnia, and tracheal occlusions is greatly depressed in rapid-eye-movement (REM) sleep compared with slow-wave sleep (SWS). The aim of this study was to compare the arousal thresholds in SWS and REM sleep in response to an upper airway pressure stimulus. We compared the waking responses to tracheal (T) vs. nasal (N) occlusion in four unanesthetized, naturally sleeping dogs. The dogs either breathed through a tracheal fistula or through the snout using a fiberglass mask. A total of 295 T and 160 N occlusion tests were performed in SWS and REM sleep. The mean time to arousal during N and T tests was variable in the same dog and among the dogs. The mean time to arousal in SWS-tracheal occlusion was longer than that in N tests in only two of the four dogs. The total number of tests inducing arousal within the first 15 s of SWS-nasal occlusion tests was significantly more than that of T tests (N: 47%; T: 27%). There was a marked depression of arousal within the initial 15 s of REM sleep in T tests compared with N tests (N: 21%; T: 0%). The frequency of early arousals in REM tests was less than that of SWS for both N and T tests. The early arousal in N occlusion is in sharp contrast to the well-described depressed arousal responses to hypoxia, hypercapnia, and asphyxia. This pattern of arousal suggests that the upper airway mechanoreceptors may play an important role in the induction of an early arousal from nasal occlusion.

Topics: Airway Obstruction; Animals; Arousal; Asphyxia; Dogs; Hypercapnia; Hypoxia; Nose; Sleep; Sleep, REM; Trachea

The indications for surgery of congenital choanal atresia and the different surgical approaches are discussed in detail. The transnasal approaches should be done only in emergency situations or as first-aid treatment; the transmaxillary approach is not important today. The transpalatinal approach in the head-down position under microsurgical conditions has proved to be much better. Thirty-six cases with congenital choanal atresia were observed in 15 years. Thirty-four patients were operated on in infancy or childhood and controlled later on. Four children showed bilateral choanal atresia; the other patients had unilateral complete atresia. In 8 patients a transnasal approach was done, in 6 cases there was a recurrence in the form of a complete stenosis and after transpalatinal re-operations there was a relapse in only one case. One patient was operated on the transmaxillary approach. In 25 cases the transpalatinal approach was the method of operation; relapse was seen in 5 cases only and could be revised by transpalatinal approach, one case excepted. Own experience and the present results show that the transpalatinal approach is suitable for adults as well as newborn babies and infants. On account of the better view of the operating area and optimal reconstructive conditions, the transpalatinal approach appears to be safer and long-term results are good.

Topics: Adult; Airway Obstruction; Child; Choanal Atresia; Follow-Up Studies; Humans; Maxilla; Nasal Septum; Nose; Palate

Topics: Airway Obstruction; Birth Injuries; Female; Humans; Infant, Newborn; Mouth Breathing; Nose; Time Factors

Topics: Aged; Airway Obstruction; Ear; Humans; Inflammation; Male; Nose; Polychondritis, Relapsing; Skin Diseases; Trachea

The controversy concerning the effects of nasal airway impairment on facial growth has stimulated renewed interest in upper airway respiratory function. We assessed the relationship between nasal airway patency and nasal airflow rate, using the pressure-flow technique to estimate nasal cross-sectional size and nasal airflow rate in 30 normal and 82 nasally impaired adults. Groups were categorized according to otolaryngologic examination results and pressure-flow measurements. The results clearly demonstrate that size of the airway influences airflow rate when the smallest nasal cross-sectional area is under 0.4 cm2. The data suggest that the nose becomes flow-limiting when it is less than 0.18 cm2. These data support our contention that nasal airway impairment in adults occurs when the airway is less than 0.4 cm2 in size.

Topics: Adult; Airway Obstruction; Airway Resistance; Humans; Models, Biological; Nose; Pulmonary Ventilation

Topics: Airway Obstruction; Humans; Nose; Nose Diseases; Prostheses and Implants; Prosthesis Design

Topics: Airway Obstruction; Child; Humans; Malocclusion; Mouth Breathing; Nose; Orthodontics, Corrective

Although there has been considerable interest in the effects of nasal airway impairment on facial growth, the relationship is still unclear. This study examined the effect of nasal airway size on upper airway pressures during breathing. Three phases of data collection were involved. The first phase used a model to describe pressures during simulated normal and impaired respirations. The second phase involved subjects with normal airways, and the third used persons who were judged by an otolaryngologist to be nasally impaired. Aerodynamic assessment techniques were used to measure airway pressures during breathing and to assess nasal airway size. Results of the modeling study suggest that when nasal cross-sectional area is greater than 0.1 cm2, pressures associated with breathing are not excessive. These findings also suggest that slight lip opening (2 to 3 mm) would significantly reduce airway pressures. In addition, pressure magnitudes of the normal and nasally impaired groups were similar to the modeling data, and no significant difference in pressures was observed between the two groups. Accordingly, the assumptions that nasally impaired persons generate abnormal breathing pressures and that these pressures directly influence facial growth are questionable.

Topics: Air Pressure; Airway Obstruction; Airway Resistance; Humans; Maxillofacial Development; Models, Anatomic; Models, Biological; Mouth; Mouth Breathing; Nasopharynx; Nose; Pulmonary Ventilation; Respiration

Topics: Adolescent; Adult; Airway Obstruction; Electromyography; Female; Head; Humans; Male; Mandible; Masticatory Muscles; Middle Aged; Mouth Breathing; Muscles; Neck Muscles; Nose; Posture

The purpose of this article is to test the hypothesis that the establishment of nasal respiration in children with severe nasopharyngeal obstruction can be eliminated as a factor in determining mandibular growth direction. The article describes the changes in mandibular growth direction (MGD) in a 5-year period after adenoidectomies and the establishment of nasal breathing in a population of Swedish children. Measurements of mandibular growth directions were obtained from serial cephalometric radiographs after adenoidectomies in 38 Swedish children aged 7 to 12 years with previous nasopharyngeal obstructions. These were compared with the growth directions in a control sample of 37 Swedish children with clear airways and matched for age and sex. The adenoidectomy sample initially showed significantly longer lower face heights, steeper mandibular plane angles, and more retrognathic mandibles than the matched controls. Analysis showed that during the 5 years after adenoidectomies, the girls had a more horizontal MGD (P less than 0.02) than did the female controls. A corresponding but not significant trend was found for the boys. The individual growth directions that were obtained following adenoidectomies were more variable than those found in the controls.

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Cephalometry; Child; Chin; Female; Humans; Male; Mandible; Mouth Breathing; Nose; Nose Diseases; Pulmonary Ventilation; Radiography; Sex Factors; Subtraction Technique

32 patients with habitual snoring and 2 patients with obstructive sleep apnea syndrome underwent nasal and/or palatopharyngeal surgery. 12 patients with combined nasal septoplasty, submucous resection of the inferior turbinate bones and palatopharyngoplasty gained total relief from snoring. The same result was achieved in 10 children with removal of extremes of tonsillar and adenoid enlargement. From 7 patients with nasal surgery alone 4 experienced total improvement in the snoring, 3 perceived no long-term relief. 3 adults with PPP alone gained some change in their snoring. Uvulectomy in 2 adults had no influence on the snoring situation.

Topics: Adenoidectomy; Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Nose; Palate; Pharynx; Sleep Apnea Syndromes; Snoring; Suture Techniques; Tonsillectomy; Uvula

Topics: Airway Obstruction; Child; Ear; Emergencies; Epistaxis; Foreign Bodies; Humans; Nose; Tracheostomy

Twenty per cent of all deformities of the external nose are saddle noses; this common deformity is an aesthetic as well as a functional problem. These two factors must be respected in planning an operative correction. There are different methods applicable depending on the size of the defect and these will be demonstrated in this paper.

Topics: Airway Obstruction; Cartilage; Humans; Nasal Septum; Nose; Rhinoplasty

Topics: Airway Obstruction; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Prostheses and Implants; Pulmonary Ventilation

Topics: Airway Obstruction; Airway Resistance; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Maxillofacial Development; Nasal Mucosa; Nose; Nose Diseases; Respiratory Tract Infections; Sleep Apnea Syndromes

Brief end-expiratory airway occlusions were performed in 22 preterm babies, 17 with and 5 without clinical apnea, and 4 full-term babies, 1 with Pierre-Robin syndrome. Airway stability was evaluated by comparing pressures measured simultaneously in the chest and nasal passages during occluded inspiratory efforts. The airway remained patent throughout all 301 trials in 20 babies during rapid-eye-movement (REM) and quiet sleep. Airway closure occurred during 31/102 trials in 6 babies (5 preterm and 1 term with Pierre-Robin syndrome), more commonly in quiet than in REM sleep. Overall and within individuals, mean closing pressures were significantly lower than the mean maximum falls in airway pressure recorded during occlusions without closure. Mixed-obstructive and obstructive apnea was significantly more frequent in babies with airway closure than in those without (5.3 +/- 4.0 vs. 0.4 +/- 0.8 episodes/h). Pauses in breathing greater than or equal to 3 s occurred during 28% of occlusions in preterm infants and 2% of occlusions in full-term babies. There was no significant difference between the mean frequency of pauses during occlusion and during the preceding control period or in the incidence of pauses in occlusions with vs. those without closure. It is concluded that the airway of most preterm and full-term babies is remarkably stable under load. Intermittent closure occurs in certain infants and may be related to airway muscle dysfunction.

Topics: Airway Obstruction; Apnea; Female; Humans; Infant; Infant, Newborn; Male; Nose; Respiration; Sleep, REM

Nasal respiratory function and its relationship to growth development of the craniofacial structure has been a subject of interest and controversy for over 100 years. The otolaryngologist as the primary physician with responsibility of managing the upper respiratory tract is obviously most intimately involved with diagnosis and treatment of upper respiratory tract problems. To further evaluate the evidence regarding causes of craniofacial growth, a study was done involving pretreatment orthodontic subjects and their manifestation of classic signs of adenoid facies ("long-face syndrome"). Randomly selected were 106 subjects, ranging in age from 6 to 13 years, for evaluation of the facial features and medical history associated with long-face syndrome. No conclusive proof was found that nasal respiratory obstruction alters facial growth development. Studies of the nasal respiratory function need to be done utilizing clear definitions of respiratory mode and objective; reproducible techniques of measuring respiratory modes must be employed. Highly selected orthodontic patients can benefit from adenoidectomy and/or tonsillectomy.

Topics: Adolescent; Airway Obstruction; Cephalometry; Child; Facial Bones; Female; Humans; Male; Malocclusion; Maxillofacial Development; Mouth Breathing; Nose; Random Allocation; Respiration; Syndrome

Nasal obstruction has been shown to increase the number of apneas during sleep in normal subjects and in some may actually cause the sleep apnea syndrome. We postulated that the pharynx may act as a Starling resistor, where increases in negative inspiratory pressure result in elevated resistance across a collapsible pharyngeal segment. To test this theory in normal subjects we studied 10 men and 10 women during wakefulness. Pharyngeal resistance (the resistance across the airway segment between the choanae and the epiglottis) was determined in the normal state and with three inspiratory loads added externally. Flow was measured using a pneumotachometer and a sealed face mask; epiglottic pressure by a latex balloon placed just above the epiglottis and choanal pressure by anterior rhinometry. Pharyngeal resistance (measured at 300 ml/s) could thus be determined. Base-line inspiratory pharnygeal resistance was 1.6 +/- 0.2 cmH2O . l-1 . s. This increased to 2.3 +/- 0.3, 2.8 +/- 0.4, and 2.9 +/- 0.4 cmH2O . l-1 . s, respectively, with the addition of 1.3, 2.7, and 6.7 cmH2O . l-1 . s inspiratory load. The resistance at each level of load was significantly different from the base-line resistance determination (P less than 0.05) but not different from each other. We conclude that added nasal resistive loads during inspiration cause an increase in pharyngeal resistance during wakefulness but that this resistance does not increase further with additional increments of load.

Topics: Adult; Airway Obstruction; Airway Resistance; Female; Humans; Male; Middle Aged; Nose; Pharynx; Sleep Apnea Syndromes; Work of Breathing

Partial nasal obstruction was performed during a morning of quiet sleep (QS: non-REM) and active sleep (AS: REM) at ages 1 week, 2 weeks, 1, 2, 3, 4 and 6 months on 12 normal infants, 15 subsequent siblings of victims of the Sudden Infant Death Syndrome (SIDS) and 12 infants admitted for investigation of infant apnoea ('near-miss' SIDS). In all three groups the numbers failing to arouse after 240 s (FTA-240) in QS were significantly greater than those in AS. After 2 months of age all groups showed a decrease in the number FTA-240 in AS, whereas in QS the number did not change significantly. Subsequent siblings of SIDS had a significantly higher number FTA-240 in QS than controls. There was no significant difference in FTA-240 in QS between controls and infant apnoeas, although there was a trend for this to be higher in subsequent siblings of SIDS than infant apnoeas. It was concluded that arousal from AS is more marked than from QS, that after 2 months of age the ability to arouse from AS increases, and that in relation to SIDS, QS is the sleep state in which the infant is less able to arouse. Furthermore, subsequent siblings of SIDS differ from normal infants in their ability to arouse from QS.

Topics: Airway Obstruction; Arousal; Electrocardiography; Female; Heart Rate; Humans; Infant; Infant, Newborn; Male; Monitoring, Physiologic; Nose; Respiration; Sleep; Sleep Apnea Syndromes; Sleep, REM; Sudden Infant Death; Time Factors

Fetal alcohol syndrome is a well-known entity, but its association with upper airway anomalies has not been established. We describe three patients, all of whom had fetal alcohol syndrome and upper airway obstruction. Recognition of this problem is important, as it may help to prevent serious complications such as obstructive apnea, sudden infant death syndrome, or pulmonary hypertension in these already compromised infants.

Topics: Abnormalities, Multiple; Adult; Airway Obstruction; Female; Fetal Alcohol Spectrum Disorders; Humans; Infant, Newborn; Larynx; Male; Nose; Pregnancy

Topics: Adolescent; Adult; Airway Obstruction; Child; Cryosurgery; Ethmoid Bone; Female; Humans; Hypertrophy; Male; Middle Aged; Nose

Topics: Airway Obstruction; Airway Resistance; Humans; Manometry; Nose; Nose Diseases

This project examined modeled velopharyngeal orifice area estimation under conditions simulating voiceless stop consonant production in the presence of nasal airway obstruction. The results indicated that accurate estimates of velopharyngeal orifice area can be obtained using Warren's hydrokinetic equation during aerodynamic events like those known to exist during speech in the presence of increased nasal airway resistance. These findings provide support for clinical and research use of Warren's pressure-flow approach to investigate velopharyngeal function during speech production.

Topics: Airway Obstruction; Airway Resistance; Cleft Lip; Cleft Palate; Forecasting; Humans; Models, Biological; Nose; Palate, Soft; Pharynx; Phonetics; Pressure

A technique is described to reconstruct the normal degree of projection of the alar dome of the unilateral cleft lip nose by leapfrogging the spreadeagled alar cartilage up onto the back of the sturdy septum and upper lateral cartilage arch. The medial crus enclosed in a hemiforked flap slides along the membranous septal incision; the lateral crus slides along the intercartilaginous incision; they join each other as the stem of a Y, where they are secured in their new relationship to the septum and upper lateral cartilage. As the limbs approach each other, a standing cone creates the dome projection externally and a fornix within. The dipped rim rises and the charming nasal dimple reappears. Almost 200 primary cases of unilateral cleft lip nose have been treated by this technique over the past 12 years by the author. Alar dome and alar rim relapse have been infrequent. Less than 5 per cent of patients (or parents) have requested revision up to puberty. Final assessment of the effect of this radical surgery may well require a further 10 years' follow-up.

Topics: Airway Obstruction; Cartilage; Child; Child, Preschool; Cleft Lip; Follow-Up Studies; Humans; Infant; Lip; Nose; Postoperative Complications; Rhinoplasty; Surgical Flaps; Suture Techniques

Report on an extradural meningioma of the left nasal cavity and ethmoid sinus with secondary extension into the subfrontal region in an 18-year old male. Review of 37 similar cases reported in literature. These slowly growing non-infiltrating tumours cause nasal obstruction and sinusitis but have no characteristical clinical symptoms. The origins of these tumours are obviously arachnoideal meningocytes which accompany the olfactory filaments through the lamina cribrosa to the extradural site.

Topics: Adolescent; Airway Obstruction; Ethmoid Sinus; Humans; Male; Meningioma; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

Newborn infants are considered obligate nasal breathers, hence dependent on a patent nasal airway for ventilation. The conditions under which oral breathing could occur and the contribution of oral ventilation to total ventilation were studied in 30 healthy term infants (aged 1 to 3 days). Nasal and oral airflow were measured using two resistance-matched pneumotachometers, and heart rate, tcPO2, etCO2, and sleep state were continuously recorded. In three of 10 infants studied in undisturbed sleep, spontaneous oronasal breathing was noted during both active and quiet sleep (mean duration 19 +/- 25 minutes), the distribution of tidal volume being 70% +/- 12% nasal and 30% +/- 12% oral. Episodes of oronasal breathing were also observed after crying in six infants (mean duration 21 +/- 19 seconds). In an additional 20 infants, multiple 15-second end-expiratory nasal occlusions were performed; eight (40%) of these infants initiated and sustained oral breathing in response to nasal occlusion. Respiratory rate, tidal volume, heart rate, and tcPO2 did not change when oral breathing occurred in response to nasal occlusion, although minute ventilation decreased from 265 to 199 ml/min/kg (P less than 0.05). These results demonstrate that newborn infants may use the oral airway for ventilation, both spontaneously and in response to complete nasal occlusion.

Topics: Airway Obstruction; Crying; Humans; Infant, Newborn; Mouth Breathing; Nose; Respiration; Respiration, Artificial; Sleep

Rhinometry has provided a quantitative and objective means of assessing nasal airway patency. Previous investigators have established normal nasal resistances for adults and newborn infants. Less material and no such normal references are available for the pediatric ages. In this study, nasal airway resistance is assessed by anterior rhinometric technique in 498 children ranging from four to 16 years of age. Collected nasal resistance data are found to vary inversely with age and fall in an almost linear fashion between already established normals of infancy and adulthood. As far as we can determine, pediatric age specific nasal resistance data with calculated standard deviations and 95% confidence levels have not been previously reported. Such data provides initial age specific reference points enabling the rhinologist to more objectively evaluate concerns regarding nasal obstructive problems in children.

Topics: Adolescent; Age Factors; Airway Obstruction; Airway Resistance; Child; Child, Preschool; Female; Humans; Male; Nose; Nose Diseases

Total inferior turbinectomy has been proposed as a treatment for chronic nasal airway obstruction refractory to other, more conservative, methods of treatment. Traditionally, it has been criticized because of its adverse effects on nasophysiology. In this study, patients who had previously undergone total inferior turbinectomy were evaluated with the use of an extensive questionnaire. It confirms that total inferior turbinectomy carries significant morbidity and should be condemned.

Topics: Adult; Airway Obstruction; Chronic Disease; Evaluation Studies as Topic; Follow-Up Studies; Humans; Nose; Nose Diseases; Olfaction Disorders; Postoperative Complications; Rhinitis; Rhinitis, Atrophic; Turbinates

Topics: Adult; Airway Obstruction; Humans; Intubation, Intratracheal; Male; Nose

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Airway Resistance; Child; Humans; Manometry; Nasal Provocation Tests; Nose; Nose Diseases; Postoperative Period; Rhinitis; Sinusitis

Eighteen children were treated for snoring. Surgical removal of enlarged tonsils and/or adenoids resulted in prompt and total elimination of snoring in 17 of these patients. One child required nasal and sinus surgery to gain relief from snoring. Eighty-three adults were interviewed, examined, and treated for snoring. Correction of anatomical abnormalities in the nose, soft palate, uvula, and pharynx achieved elimination of snoring in 72% of surgically treated cases. By contrast, nonsurgical remedies achieved snoring elimination in only 5% of patients (controls). Tracheostomy was required in 10% of snoring adults--those who proved to have severe obstructive sleep apnea syndrome. Snoring is due to the combined effect of several anatomic and physiologic abnormalities in the nasal and pharyngeal segments of the airway. It may be amenable to surgical therapy when the severity of the problem warrants it.

Topics: Adenoidectomy; Adolescent; Adult; Aged; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Muscle Tonus; Nasal Mucosa; Nasal Septum; Nose; Palate, Soft; Pharyngeal Muscles; Pharynx; Respiratory Sounds; Sleep Apnea Syndromes; Snoring; Tonsillectomy; Tracheotomy; Turbinates; Uvula

Neuromuscular changes were studied by electromyography in rhesus monkeys which adapted to nasal obstruction for 2 years and then in the succeeding year recovered to nasal respiration. Obstructing the nasal passage with silicone plugs induced specific behavioral responses which remained for the duration of nasal obstruction and were lost within 8 days after removal of the plugs. Animals demonstrated individual variations, but more than 80% consistently maintained a lower mandibular posture for the entire 2-year period. Rhythmic mandibular, tongue, and upper lip movements were evident in fewer than 60% of the animals. Certain craniofacial and tongue muscles (the genioglossus, dorsal tongue fibers, digastric, geniohyoid, dilator naris, and vertically oriented fibers of the superior orbicularis oris, that is, lip-elevator fibers) were recruited rhythmically and remained rhythmically active throughout the entire 2-year period of nasal obstruction. This rhythmic activity ceased within 1 week after removal of the nose plugs. A tonic or consistent discharge was also induced in the genioglossus, dorsal tongue fibers, the geniohyoid, superior orbicularis oris, and lip-elevator fibers over the entire 2 years of nasal obstruction. Not all muscles lost their tonic discharge after removal of the nasal plugs. The genioglossus, geniohyoid, inferior orbicularis oris, and lip-elevator fibers discharged tonically during the recovery period. These data suggest that nasal obstruction can induce neuromuscular changes which extend beyond the period of obstruction and remain after the original stimulus for neuromuscular change has been removed.

Topics: Airway Obstruction; Animals; Electromyography; Facial Muscles; Female; Lip; Macaca mulatta; Male; Mandible; Masticatory Muscles; Mouth; Muscle Tonus; Nose; Tongue

The standard treatment in ENT and plastic surgical departments of a fractured nose is closed manipulation. Two recent retrospective studies have cast doubt on the value of this manoeuvre. This review of 70 patients between one and three years following injury shows that only 26% had a normal appearance and 48% had normal function. The presence of a septal fracture is of prime importance in determining the outcome.

Topics: Adolescent; Adult; Airway Obstruction; Female; Follow-Up Studies; Fractures, Bone; Humans; Male; Manipulation, Orthopedic; Middle Aged; Nose

The controversy concerning the effects of impaired nasal respiration on dentofacial development stems largely from the lack of a reliable method to assess airway impairment. The purpose of this study was to develop and validate a quantitative technique to estimate nasal airway dimensions so that normal and impaired nasorespiratory function could be defined. The method involves a modification of the theoretical hydraulic principle and utilizes the following equation to estimate cross-sectional area of the nose (NA): NA = V/K [2(delta P)/d] 1/2 (where d = density of air). Pressure drop (delta P) across the nose is measured simultaneously with airflow (V) through the nose during breathing, using appropriate transducers and a PDP 11/34 computer. An analog model of the upper airway was used to determine the discharge coefficient (k) and estimate measurement error. Model studies demonstrate a measurement error of less than 5% for nasal cross-sectional areas of 0.02 to 1.2 cm2. Studies involving eighteen adult subjects and twenty-six children 8 to 11 years of age revealed mean smallest cross-sectional nasal areas of 0.62 cm2 +/- 0.17 and 0.43 cm2 +/- 0.076, respectively. The results indicate that the technique should enable clinicians to (1) estimate size of the airway during breathing, (2) distinguish between normal and impaired nasal respiratory function, and (3) determine quantitatively the effects of surgical and/or orthodontic treatment for improving nasal respiration.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Child; Equipment Design; Humans; Manometry; Models, Biological; Mouth; Mouth Breathing; Nose; Nose Diseases; Pulmonary Ventilation; Transducers, Pressure

Topics: Adolescent; Airway Obstruction; Child; Esthetics; Humans; Nose; Nose Diseases; Rhinoplasty

Eight children with obstructive apnea were evaluated by transnasal fiberoptic endoscopy. Three children had obstructive adenoids and tonsils, 2 had pharyngeal collapse, 1 had an obstructive tongue, and 1 had a subglottic cyst. The remaining patient had no abnormality. The results of transnasal endoscopy influenced therapeutic interventions.

Topics: Airway Obstruction; Apnea; Child, Preschool; Endoscopy; Female; Fiber Optic Technology; Humans; Infant; Male; Nose; Pharyngeal Diseases

Topics: Airway Obstruction; Humans; Mouth Breathing; Nose; Pulmonary Ventilation; Respiration; Syndrome

Topics: Airway Obstruction; Humans; Manometry; Nose

Topics: Airway Obstruction; Child; Female; Humans; Male; Manometry; Mouth Breathing; Nose; Pulmonary Ventilation

Topics: Airway Obstruction; Female; Humans; Male; Malocclusion; Maxillofacial Development; Nose; Rhinitis, Allergic, Perennial

Aspects of rhinoplasty aesthetics as applied to the common nasal deformities have been presented with some comments on present day ethical considerations of this surgery. Airway obstruction due to vestibular narrowing with some alternatives for management are discussed.

Topics: Airway Obstruction; Cartilage; Esthetics; Ethics, Medical; Female; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty

Topics: Adult; Airway Obstruction; Child; Ear; Endoscopy; Esophagus; Foreign Bodies; Humans; Larynx; Nose; Pharynx; Radiography

Early signals of pathologic causes of nasal obstruction in childhood may pass unnoticed by the unsuspecting physician because these signals mimic innocuous problems such as the common cold, sinusitis, and allergic rhinitis. The hope for early recognition of the more serious causes of nasal obstruction in children depends upon a high degree of suspicion. Some of the common and uncommon causes of nasal obstruction are enumerated by categorizing the possible etiologies into congenital, traumatic, iatrogenic, inflammatory, and neoplastic classifications. With a systematic approach that utilizes history, physical examination, and special diagnostic studies, misdiagnosis can be avoided and treatment initiated more rapidly and effectively.

Topics: Airway Obstruction; Child; Cysts; Encephalocele; Foreign Bodies; Humans; Nasopharyngeal Diseases; Nose; Nose Diseases; Nose Neoplasms; Rhinitis

The effect of alae nasi activation on nasal resistance in a group of healthy preterm infants was measured. Alae nasi activity was determined via the alae nasi electromyogram obtained from skin surface electrodes during both active and quiet sleep. Nasal resistance was calculated from airflow measured with a mask pneumotachograph and transnasal pressure drop obtained by simultaneous measurement of nasal pressure via a catheter inserted in one nostril and mask pressure. The percentage of breaths accompanied by phasic alae nasi activity was higher during active sleep than during quiet sleep (43% +/- 10% v 14% +/- 6%; P less than .005), and hypercapnic stimulation (4% CO2 inhalation) significantly increased the incidence of phasic alae nasi activity to comparable levels in both sleep states (82% +/- 8% in active sleep and 82% +/- 9% in quiet sleep). Elevation of tonic alae nasi activity also occurred more frequently during active sleep (P less than .05). The presence of either phasic or elevated tonic alae nasi activity decreased nasal resistance by 23% +/- 4% during active sleep and 21% +/- 3% during quiet sleep. This reduction in nasal resistance resulted in either a lower transnasal pressure during inspiration, a higher peak inspiratory airflow, or a combination of the two. Alae nasi activity may be an important mechanism that facilitates ventilation by reducing nasal resistance, and it may help stabilize the upper airway by preventing the development of large negative pharyngeal pressure during inspiration.

Topics: Airway Obstruction; Airway Resistance; Electromyography; Humans; Infant, Newborn; Infant, Premature; Nose; Sleep Apnea Syndromes

Previous observers have suggested that the main site of respiratory airflow resistance is localized to the vestibular region of the nose. This resistive segment of the airway was investigated using a "head-out" body plethysmograph in subjects with anatomically normal noses (a) untreated, (b) congested and (c) decongested. In all three conditions, 2/3 of the total nasal airflow resistance was found within the bony cavum in the vicinity of the pyriform aperture and about 1/3 in the cartilaginous vestibule. As might be expected, caval resistance changed proportionately with the degree of mucosal congestion; but, more surprisingly, vestibular resistance changed similarly. This was due in part to the observed forward expansion of the anterior ends of the inferior turbinates with congestion. EMG recordings in subjects breathing through both nostrils demonstrated a gradation of inspiratory alar dilator muscle activity with increased minute ventilation and with mucosal congestion, and there was no evidence of inspiratory alar collapse. But with elevated ventilation through one nostril only, or when the alar muscles were paralyzed by lidocaine block of the VIIth nerve, alar collapse occurred. These findings are of importance in the management of the congested but anatomically normal nose and in surgery of the nasal tip.

Topics: Adult; Airway Obstruction; Airway Resistance; Electromyography; Facial Nerve; Female; Humans; Male; Middle Aged; Nasal Bone; Nasal Cavity; Nasal Mucosa; Nerve Block; Nose; Plethysmography; Pressure; Respiration

The present study was designed to test the hypothesis that a feedback loop relaying information on the patency of one nasal cavity might be processed by the central nervous system to modify the vascular engorgement of the other, thereby minimizing total airflow resistance alterations during the nasal cycle. Histamine and xylometazoline were used to alter the degree of mucosal swelling and a cotton plug to alter airflow, in one nasal cavity and resistance measurements were made from its fellow. No changes in the latter were observed. It was concluded that this feedback arc does not exist.

Topics: Adult; Airway Obstruction; Airway Resistance; Feedback; Histamine; Humans; Imidazoles; Nasal Cavity; Nasal Mucosa; Nose

Topics: Abdomen; Airway Obstruction; Airway Resistance; Facial Bones; Humans; Lung; Maxillofacial Development; Morphogenesis; Mouth; Mouth Breathing; Nose; Posture; Respiration; Thorax

Nasopharyngeal airways have been assessed in the management of infants with severe Pierre Robin syndrome. In 12 such infants the positioning and subsequent maintenance of these tubes were found to be important in ensuring adequate relief of the airway obstruction. In five infants measurements of lung mechanics demonstrated the benefits of NP tube placement and confirmed the observed improvements in cyanotic episodes, heart failure, electrocardiograms, and arterial gas tensions. In a retrospective survey of 40 infants with PRS, failure to thrive was found to be significantly correlated with the severity of the airflow obstruction. This failure to thrive was reversed in the infants managed with NP tubes in comparison with an age-matched groups nursed while prone. The lack of significant complications with the NP airway and its acceptability to nursing staff, patients, and their parents suggest that this method deserves more widespread use in PRS and perhaps in other situations in which high upper respiratory tract obstruction is predominant.

Topics: Airway Obstruction; Body Weight; Female; Humans; Infant; Intubation; Male; Nose; Pharynx; Pierre Robin Syndrome; Posture; Retrospective Studies; Work of Breathing

Topics: Airway Obstruction; Humans; Male; Nose; Sleep Apnea Syndromes; Sleep Wake Disorders; Time Factors

The tongue-retaining device (TRD) was designed to increase the unobstructed dimension of the nasal breathing passage during sleep. Twenty male patients with diagnoses of sleep apnea syndrome, primarily of the obstructive type, confirmed by clinical polysomnography, were fitted with the device. The TRD holds the tongue in a forward position by negative pressure. Fourteen patients have been tested before and after this treatment, and ten of these have also completed two follow-up recordings four to six months after being trained in the use of this device. There was significantly improved sleep and significantly fewer and shorter apneic events on all nights when the device was worn. On the first night of wearing the TRD for a half night only, there was a significant reduction in the number of obstructive and central apneic episodes. The mean apnea plus hypopnea index while wearing the TRD is comparable with the rate reported for patients who have been treated surgically by either tracheostomy or by uvulopalatopharyngoplasty, although the tracheostomy group contained more severe cases.

Topics: Adult; Airway Obstruction; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages; Tongue

Five patients with severe obstructive sleep apnoea were treated with continuous positive airway pressure (CPAP) applied via a comfortable nose mask through the nares. Low levels of pressure (range 4.5-10 cm H2O) completely prevented upper airway occlusion during sleep in each patient and allowed an entire night of uninterrupted sleep. Continuous positive airway pressure applied in this manner provides a pneumatic splint for the nasopharyngeal airway and is a safe, simple treatment for the obstructive sleep apnoea syndrome.

Topics: Adolescent; Adult; Airway Obstruction; Carbon Dioxide; Hemoglobins; Humans; Male; Middle Aged; Monitoring, Physiologic; Nose; Oxygen; Positive-Pressure Respiration; Respiration; Sleep; Sleep Apnea Syndromes; Time Factors

A group of 31 subjects were subjected to complete artificial obstruction of the nose for a period of one hour. Their ages ranged from 14 to 16 years. Prior to the experiment the subjects were found to be healthy. During the nasal obstruction there was a fall in pO2 and an increase in pCO2 due to the hindered ventilation.

Topics: Adolescent; Airway Obstruction; Carbon Dioxide; Humans; Hydrogen-Ion Concentration; Hypoventilation; Nose; Oxygen

Topics: Adolescent; Airway Obstruction; Child; Female; Humans; Male; Mouth Breathing; Nose; Palatal Expansion Technique; Respiration

Relatively little has been published about upper lateral cartilage abnormalities, trauma, and management in rhinoplastic literature. In this paper we would like to present a relatively common problem seen either by trauma or as a result of rhinoplasty. The upper lateral cartilages are a pair of triangular cartilages, one on each side of the dorsum, which comprise the upper cartilaginous vault with the septum and can be avulsed due to direct trauma. This results in loss of their attachments and resultant healing in a new angulated position. The middle third of the nose, being relatively mobile is less susceptible to trauma than the upper third which is rigid and comprised of bone, and that frequently is the reason for less incidence of avulsion of the upper lateral cartilages compared to fractured nasal bones. The surgical treatment of the structures adjacent to the upper lateral cartilage during the process of rhinoplasty severs many attachments of these cartilages and frequently causes them to be free floating. This may not be recognized and not treated. Lack of appropriate realignment in the normal anatomical position may heal the cartilage in a distorted angulated position. Irrespective of etiology, when distortions of the upper lateral cartilage occur, they may cause significant concavity and "hollowed out" appearance on the side of the avulsion which functionally may impede the nasal airway by encroachment and/or "flutter valve" effect. During inspiration this unsupported upper lateral cartilage may interfere with anatomy, physiology and efficiency of the internal nasal valve function. Avulsion of the upper lateral cartilage is a definite entity and should be recognized and treated appropriately to realign the lateral cartilage in its normal anatomical position for a functional as well as a good cosmetic result.

Topics: Adult; Airway Obstruction; Cartilage; Diagnosis, Differential; Female; Functional Laterality; Humans; Male; Methods; Nasal Bone; Nose; Rhinoplasty; Time Factors

The approach to surgery of the crooked nose has changed significantly in the last two decades due in a large measure to a better understanding of the growth, anatomy, and physiology of the nose. The crooked nose often presents a challenging problem to the surgeon because of the multiplicity of deformities. In most cases, deformities of the external bony and cartilaginous nose, septum and turbinates must all be corrected simultaneously in order to obtain a satisfactory and lasting restoration of the nasal airway as well as the external nasal configuration.

Topics: Adult; Aging; Airway Obstruction; Female; Humans; Nasal Septum; Nose; Tomography

Nasal obstruction is known to cause abnormal ventilation during sleep in infants, but its effects on breathing and oxygenation during sleep in adults are unknown. However, in adults, obstruction of the nose by nasal packing has been shown to cause hypoxia, and on occasion, hypercarbia and sudden death. We have investigated the pattern of ventilation and the level of oxygenation during sleep in seven patients who had nasal packs after nasal polypectomy or septoplasty. Using standard polysomnographic techniques, we monitored chest wall motion, nasal and oral airflow, and arterial oxygen saturation and sleep stages. Nasal packing either caused or worsened sleep-disordered breathing in all patients and significantly increased the number, duration, and frequency of episodes for the group as a whole. Several patients also had a greatly increased number and severity of episodes of nocturnal oxygen desaturation. This study shows that obstruction of the nose by packing causes marked alterations in breathing during sleep in adults.

Topics: Airway Obstruction; Humans; Hypoxia; Male; Nose; Nose Diseases; Oxygen; Respiration Disorders; Respiratory Function Tests; Sleep; Tampons, Surgical

Four healthy adults with normal nose were asked to pedal an ergometer for 3 min or more at a load of 25, 50, and 75 W/min, respectively. The same procedure was repeated on the same subjects whose nostrils were plugged. Air-flow and pressure difference between the mesopharynx and the nares, FO2 and FCO2, percutaneous-PO2 and ScO2 were recorded on a polygraph. At the start of the exercise, respiration deepened. Nasal resistance (Rn) decreased within 30 s and kept low while the exercise lasted. TcPO2 initially increased slightly for 1 min, then decreased. ScO2 also showed the same pattern, but of very slight range. At the end of the exercise Rn returned to pre-exercise level after slight rebound increase. Recovery of tcPO2 delayed for 30 s and its rebound increase lasted for more than 5 min. In case of nasal obstruction, such sequential changes of these parameters were of the same pattern as those in normal noses but were more evident. The results demonstrated that in case of moderate or severe nasal obstruction the exercise created hypoventilation despite a marked increase in the breathing activity if nasal breathing was continued.

Topics: Adult; Airway Obstruction; Airway Resistance; Humans; Hypoventilation; Nose; Physical Exertion; Respiration; Respiratory Function Tests

Topics: Airway Obstruction; Classification; Cleft Lip; Dermoid Cyst; Encephalocele; Glioma; Humans; Infant; Infant, Newborn; Nasal Cavity; Nasal Septum; Nose; Nose Diseases

By means of computer-aided posterior rhinometry, nasal airflow resistance was measured in subjects with normal and abnormal noses. Variations were less than obtained by other methods. Subjects were exposed to several common stimuli which have been reported to induce nasal mucosal changes: exercise, mechanical irritation, air pollutants, and climatic extremes. Any resistive effects were of short duration in that they could no be detected 30 minutes after exposure, but a commonly used decongestant reduced nasal resistance for several hours. Computer-aided rhinometry provides a basal level of nasal patency. Its clinical usefulness, now being tested, will be reported later.

Topics: Air Pollutants; Airway Obstruction; Airway Resistance; Computers; Humans; Imidazoles; Manometry; Nasal Decongestants; Nose; Physical Exertion; Rhinitis

Variations in natural head position have been noted by previous workers to be associated with both dentoalveolar and craniofacial skeletal morphologic features. The determinants of cranial posture are as yet not known. Three experiments are described, dealing with the influence of (1) total nasal obstruction, (2) visual feedback deprivation, and (3) a combination of (1) and (2) on the posture of the cranium measured relative to a gravity-defined true vertical reference plane. The results indicate that total nasal obstruction results in all cases in an extended head position. Visual deprivation produces adaptation of a smaller magnitude and unpredictable direction. Combination of both experimentally induced conditions indicates a dominance of the respiratory adaptation in terms of postural response to these stimuli.

Topics: Adaptation, Physiological; Adult; Airway Obstruction; Cephalometry; Feedback; Head; Humans; Nose; Posture; Respiration; Vision, Ocular

Many patients requiring maxillary surgery for the correction of dentofacial deformities have pre-existing nasal airway obstructions. In addition, some of the movements accomplished during surgery may reduce the volume of the nasal cavity or may result in nasal airway obstructions. Techniques for eliminating pre-existing nasal obstructions and of avoiding adverse effects on the nasal airway resistance after maxillary surgery are presented.

Topics: Airway Obstruction; Airway Resistance; Humans; Maxilla; Nasal Bone; Nasal Cavity; Nasal Septum; Nose; Osteotomy; Turbinates

Topics: Airway Obstruction; Female; Humans; Intraoperative Complications; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty

Rhinometry of respiratory airflow is discussed and disadvantages of invasive methods are emphasized. The stability of the series of pressure-flow relationships of respiratory air which is repeated through consecutive nasal breaths may be exploited to provide an index of nasal obstruction-different techniques and their limitations are outlined. The use of an inexpensive microprocessor interfaced with standard respiratory laboratory pressure and flow measuring apparatus is described and advocated for assessment of resistance to respiratory airflow in the nasal cavities and other flow resistant segments of the airways.

Topics: Airway Obstruction; Computers; Humans; Manometry; Methods; Nose; Otolaryngology; Pressure; Pulmonary Ventilation

Rhinoplasty is one of the most challenging surgical procedures. Surgeons should strive to obtain maximum aesthetic and functional results with minimal operative intervention. Excessive surgery often results in unwarranted impairment of nasal function. The obstructive or sensory complications of rhinoplasty can occur in the early or late postoperative periods. The most common functional sequelae of rhinoplasty, and their causes, prevention and therapy, are discussed.

Topics: Airway Obstruction; Humans; Nose; Nose Diseases; Osteotomy; Postoperative Complications; Rhinoplasty; Time Factors

Two infants presented with recurrent brief cyanotic attacks and had unilateral nasal discharge. Both were poor feeders. The triad--transient cyanotic attacks, poor feeding and unilateral nasal discharge--points to unilateral upper airway obstruction. When the obstruction was relieved, the symptoms disappeared.

Topics: Airway Obstruction; Craniofacial Dysostosis; Cyanosis; Eating; Female; Humans; Infant; Infant, Newborn; Male; Nasal Mucosa; Nose; Recurrence

The effects of aging are particularly manifested in the face. The vertical dimension of the lower third of the face decreases but the same dimension increases in the nose. The chin moves up; the nose droops down. In order to restore normal nasal physiologic function in persons who present with this type of nose, correction of the cartilaginous and occasionally the bony external nose is necessary. This produces an improved physiologic and cosmetic result.

Topics: Adult; Aging; Airway Obstruction; Cartilage; Face; Female; Humans; Male; Middle Aged; Nasal Bone; Nasal Septum; Nose; Rhinoplasty; Skin Physiological Phenomena

An infant with Pierre Robin anomaly was anaesthetised for cardiac catheterisation. There was cor pulmonale with the pulmonary artery pressure at systemic level, a patent foramen ovale and a persistent ductus arteriosus. The effects of alterations in blood gases on the haemodynamics and intracardiac shunts are considered. Subsequent management of the obstructed airway with a nasopharyngeal tube for 4 weeks is described.

Topics: Airway Obstruction; Cardiac Catheterization; Humans; Infant, Newborn; Intubation; Male; Nose; Pharynx; Pierre Robin Syndrome; Pulmonary Heart Disease

Topics: Airway Obstruction; Cleft Palate; Cysts; Humans; Nose; Oral Hygiene; Pharynx

Topics: Airway Obstruction; Common Cold; Humans; Nose; Nose Diseases; Nose Neoplasms; Respiratory Hypersensitivity

Timed vital capacity of one second, peakflow, maximum breathing capacity (maximum voluntary ventilation), maximum middle half flow rate, total vital forced expiratory and inspiratory capacities, tidal and minute volume tested via the mouth and each "nose" separately for the diagnosis of nasal airway disturbance have proved to be valuable parameters of pulmonary function for the evaluation of the degree to which each nasal chamber "loads" the effort of breathing every breath in and out of the nose. Minimum "normal" ratios of nose to mouth finding have been determined. Calculations falling below these normals indicate strongly the presence of significant nasal airway disturbance. Especially is this true when repeated testing yields constant similar results.

Topics: Airway Obstruction; Cardiovascular System; Humans; Nose; Nose Diseases; Respiratory Function Tests; Spirometry

A new parameter is introduced in active anterior rhinomanometry: the lateralization percentage, calculated as (right flow--left flow)/(right flow + left flow) x 100%. The flow was measured at 15 mm H2O pressure difference after induced shrinkage of the nasal mucosa. Two groups of subjects were studied. One group consisting of 28 male and 40 female volunteers was used to establish normal values in both sexes for flow, absolute flow difference and lateralization percentage. The second group consisting of 20 men who were to undergo submucous septal reconstruction for nasal obstruction was used to test the detection of abnormal cases when applying the normal values derived from the control group. It appeared that the absolute flow difference is a less effective measure than either the total flow or the lateralization percentage. Optimum detection (75-85% of the abnormal cases) was achieved by applying a criterion combining total flow and lateralization percentage.

Topics: Airway Obstruction; Airway Resistance; Female; Humans; Male; Manometry; Nasal Septum; Nose; Nose Diseases; Pulmonary Ventilation; Respiration; Sex Factors

Topics: Airway Obstruction; Airway Resistance; Authorship; Humans; Manometry; Nose

Lack of the upper airway function after laryngectomy creates unfavorable effects on the lower respiratory tract. The purpose of this study is to re-evaluate this relationship objectively. Respiratory function tests were performed on 13 laryngectomized patients. Pulmonary volumetry and ventilometry revealed increased RV and FRC, and decreased FEV1.0%, indicating evidence of obstructive changes in the lung, MEFV-recordings showed greater downward convexity than those of the normal at the lower volume level. The value of MEF50/body-height was definitely smaller than normal average in the same age group. Pulmonary resistance was in wide variety but definitely lower than normal because of lack of the upper airway resistance. If this component is added to the value, the total will be in normal range or even higher. Dynamic compliance remained mostly in the normal range when measured using a mask at the tracheostoma. The value was lower than normal when measured through a cuff-canula. The difference in static and dynamic compliances was greater than that in normal cases, which may indicate evidence of uneven distribution of air in the lung. Regular check-up and suitable respiratory care are recommended on the laryngectomized.

Topics: Airway Obstruction; Humans; Laryngectomy; Lung; Mouth Breathing; Nose; Respiration; Respiratory Function Tests; Respiratory Insufficiency; Trachea

Topics: Adenoidectomy; Adenoids; Airway Obstruction; Child; Cost-Benefit Analysis; Humans; Hypertrophy; Nose; Pharyngitis; Recurrence; Tonsillectomy

The historical development of nasal aerodynamic measurement is discussed. Attention is drawn to the absence of a consensus on adequate rhinometric techniques and standards, which hampers the elevation of rhinometry to the universal clinical status of audiometric, impedance, or nystagmus measurement. A computer-aided technique is described which overcomes some problems of rhinometry, by measurement of the amount of energy the body devotes to moving respiratory air through each separate nasal cavity. Although the approach is different, our preliminary results confirm previous work and suggest that assessment of the work of breathing is a promising technique in the investigation of nasal respiratory airflow.

Topics: Airway Obstruction; Airway Resistance; Humans; Manometry; Nasal Cavity; Nose; Pulmonary Ventilation; Respiration; Rheology

Topics: Airway Obstruction; Animals; Bronchi; Cardiovascular Diseases; Cilia; Dogs; Humans; Immunoglobulins; Lung; Nasal Mucosa; Nose; Paranasal Sinuses; Pharyngeal Diseases; Reflex; Respiration; Respiratory Insufficiency; Respiratory Physiological Phenomena

This study investigates the effects of surgery and bronchodilation on nasal and pulmonary resistance. The plethysmograph is evaluated as a clinical tool for nasal flow studies. The method of adapting the plethysmograph to measure nasal resistance is presented. Discriminant Function Analysis considers the effects of surgery and bronchodilatation on 15 variables. The statistical analysis of 38 cases demonstrates the benefits of improved nasal airway for pulmonary airway resistance. A review of the literature points out many of the difficulties in measuring nasal airflow. The plethysmograph emerges as an available easily adapted clinical tool that overcomes many of the short-comings in earlier techniques and in rhinomanometry. The rhinologist is offered further insight into the nasopulmonary relationship and the use of the plethysmograph to document the effects of nasal surgery.

Topics: Adolescent; Adult; Airway Obstruction; Airway Resistance; Analysis of Variance; Bronchi; Female; Humans; Lung; Male; Maximal Voluntary Ventilation; Methods; Middle Aged; Nasal Septum; Nose; Plethysmography, Whole Body; Pressure; Respiratory Function Tests; Rhinoplasty

The authors examined blood pO2 and pCO2 in patients whose noses had been tamponaded because of epistaxis, nasal surgery and in animals whose noses had been artificially obstructed. A marked fall of pO2 and an increase of pCO2 were found as well as certain differences of the gas quantities between the first and second groups of patients. For this phenomenon an explanation is given.

Topics: Adult; Aged; Airway Obstruction; Animals; Carbon Dioxide; Dogs; Epistaxis; Female; Hemostasis; Humans; Male; Middle Aged; Nose; Oxygen; Tampons, Surgical

Topics: Air Movements; Airway Obstruction; Animals; Autonomic Nervous System; Methods; Nasal Mucosa; Nerve Regeneration; Nose; Rats

Topics: Adolescent; Airway Obstruction; Airway Resistance; Child; Humans; Manometry; Nose

Topics: Airway Obstruction; Humans; Infant; Infant, Newborn; Nasopharynx; Nose

The importance of treating disturbances of nasal ventilation before any surgical intervention on the ear is stressed in many papers. It is said that ventilation of the auditory tube is not normal when respiration through the nose is handicapped. Based on these considerations, we have investigated by tympanometry the influence of abnormalities of nasal respiration measured by rhinomanometry on the auditory tube function. There was no significant relation between osseous occlusion of nasal ventilation or a swelling of the nasal mucous membranes or conchas and a dysfunction of the tube. The middle ear pressure varied within the normal range. This indicates that treatment of impaired nasal respiration before an operation on the ear is only necessary when an ascending nasal infection is feared or if there is nasopharyngeal disease.

Topics: Airway Obstruction; Ear, Middle; Eustachian Tube; Humans; Manometry; Nasal Decongestants; Nasal Mucosa; Nose; Nose Diseases; Pressure; Respiration

Obstruction of the upper and lower airways is common in horses. In the upper airway, paresis of abductor muscles of the nares and larynx allows inspiratory collapse of soft tissues, which is accentuated by factors increasing upper airway resistance and by high inspiratory flow rates. Intrapulmonary airway obstruction occurs due to accumulation of secretions, release of chemical mediators in response to a variety of stimuli, and parasympathetic stimulation of airways. Obstruction of large airways increases the work of breathing, whereas obstruction of small airways may cause no measurable increase in resistance but does cause uneven distribution of ventilation and hypoxemia, especially during exercise. Poor collateral ventilation accentuates gas exchange problems in the horse with airway obstruction and may be a factor causing intrapulmonary hemorrhage during racing.

Topics: Airway Obstruction; Airway Resistance; Animals; Bronchi; Hemorrhage; Horse Diseases; Horses; Humans; Larynx; Lung; Lung Diseases; Nose; Physical Exertion; Respiration; Respiratory Tract Infections

Topics: Adolescent; Airway Obstruction; Child; Chronic Disease; Female; Humans; Male; Nose; Nose Deformities, Acquired; Nose Diseases

Topics: Airway Obstruction; Ear Canal; Endoscopes; Esophagus; Foreign Bodies; Humans; Inhalation; Larynx; Nose; Surgical Instruments

We report a series of 88 patients in whom 119 obstructing inferior nasal turbinates were resected for airway obstruction, and who have been followed for 3 months to 3 years. The airways were consistently improved and, to date, there have been no undesirable sequelae.

Topics: Airway Obstruction; Anesthesia, General; Anesthesia, Local; Follow-Up Studies; Humans; Hypertrophy; Methods; Nasal Mucosa; Nose; Postoperative Complications; Pulmonary Ventilation; Turbinates

It appears that a variety of surgical techniques are available to safely decrease the size of hyperplastic inferior turbinates; when used properly in appropriate patients they can provide significant improvement in the symptoms of chronic nasal obstruction.

Topics: Airway Obstruction; Cryosurgery; Electrocoagulation; Humans; Hyperplasia; Methods; Nose; Nose Diseases; Rhinitis, Allergic, Seasonal; Turbinates

Topics: Airway Obstruction; Humans; Manometry; Mathematics; Nose

Topics: Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Constriction, Pathologic; Down Syndrome; Eustachian Tube; Humans; Nose; Otitis Media; Respiratory Tract Infections

The results of a septoplasty because of a nasal obstruction were studied in 261 children, their ages ranging from 4 to 14. No arrest of nasal growth after the septoplasty and osteotomies was recorded. Histological examination revealed a cartilaginous regeneration at the borders of the resected septal cartilage in 15 cases in which a second rhinoplasty was necessary because of a new nasal obstruction. Often the cartilaginous growth was undirected and excessive leading to a new septal deviation. In 80 per cent of our cases good functional long-term results were obtained by one rhinoplasty only which was performed according to the techniques of Cottle and Masing.

Topics: Adolescent; Age Factors; Airway Obstruction; Cartilage; Child; Child, Preschool; Female; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Recurrence; Regeneration; Rhinoplasty

We measured the changes in tidal volume, duration of the various phases of the respiratory cycle, and peak nasal pressure during elastic and resistive loading in preterm infants. Values were calculated during the first loaded breath, when chemical drive was unchanged. Tidal volume decreased by equivalent percentages with resistive loads of 400, 900, and 2,400 cm H2O/liter/sec, and elastic loads of 330, 1,000, and 3,000 cm H2O/liter. Infinite load was also applied (nasal occlusion). Inspiratory duration (ti) was prolonged during resistive loading, as compared with elastic loading (P less than 0.05). Changes in expiratory duration (Te) were not different with both loads (P greater than 0.05). Total duration of the respiratory cycle (T), however, tended to increase in relation to control, more so with resistive loads. Peak nasal pressure was greater with resistive than with elastic loads ( less than 0.025). We suggest that (1) preterm infants, like adult subjects and other animal species, increase inspiratory duration with resistive loads as compared with elastic loads; (2) T of the first loaded breath tends to increase with progressively larger loads and, consequently, instantaneous frequency tends to decrease; and (3) if peak nasal pressure reflects tension developed by the respiratory muscles, then the latter does not offer the inhibitory information needed to terminate inspiration.

Topics: Airway Obstruction; Airway Resistance; Female; Humans; Infant, Newborn; Infant, Premature; Male; Nose; Pressure; Respiration; Respiratory Physiological Phenomena; Tidal Volume; Time Factors

A series of 1,187 nasotracheal intubations, carried out from January 1973 to December, 1975, used a new tube. The design included a smooth tip, a cuff with a large area of contact, low pressure and a high residual volume, and a radiopaque line which is easily visible on chest X-ray. A secondary irrigating lumen opening distal to the cuff provides closed-system irrigation, measurement of airway pressures, and sampling of tracheal gases. In the 811 intubated nontracheostomized patients who survived, the overall incidence of significant laryngeal damage was 1%. In patients intubated in excess of 10 days the damage incidence was 10%, and we suggest that tracheostomy should be carried out at this time. No patients suffered from any known permanent laryngeal damage.

Topics: Adult; Aged; Airway Obstruction; Female; Hoarseness; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose; Pressure

Topics: Airway Obstruction; Central Nervous System; Child; Child, Preschool; Croup; Depression, Chemical; Epiglottis; Humans; Inflammation; Intubation, Intratracheal; Larynx; Nose; Respiratory System Abnormalities; Trachea; Tracheotomy

There is a sensory system within the mucosa of the nose and supraglottic larynx that appears to be both mechanosensitive and chemosensitive. Our data suggest that the respiratory modification produced by microaerosol inhalation represents a mechanoreceptor rather than chemoreceptor response. Furthermore, the sensitivity of this reflex system appears aged-dependent, the data indicating a more active response early in life. From a clinical perspective, it is postulated that aerosol inhalation reflex alters the pattern of breathing, resulting in improved respiratory flow rates during partial upper airway obstruction. The mechanism of a favorable clinical response to mist inhalation has not been previously appreciated in this context.

Topics: Aerosols; Age Factors; Airway Obstruction; Animals; Bronchi; Cats; Mechanoreceptors; Nose; Respiration; Respiratory Therapy; Sodium Chloride; Stimulation, Chemical; Trachea; Water

Topics: Airway Obstruction; Airway Resistance; Humans; Nose; Nose Diseases

Topics: Airway Obstruction; Ameloblastoma; Humans; Male; Middle Aged; Nose; Nose Neoplasms; Radiography

Inspiratory nasal obstruction or collapsing alae is caused by a sucking in of the candal cartilaginous parts of the nose; this is followed by a partial or complete stoppage of the inspiratory air. The nose usually assumes a pinched appearance together with a widening of the nostrils during the inspiratory phase, in cases where the collapse is confined to the upper laterals. Weakening of the upper laterals can results from development anomalies, or atrophy of the tissue with aging. Fractures of the nasal framework may cause displacement or buckling, with subsequent thickening or scar formation. This will again result in poor function. In other cases both the upper and lower lateral cartilages become involved with a resulting collapse of the lobule, producing a silit-like appearance of the nostrils. Examination of patients with inspiratory nasal obstruction will often reveal poor support of the upper laterals, deformity of the lower nasal cartilage, columella and nasal spine or dislocation of the candal parts of the septal cartilage, all of which cause obstruction to the inspiratory air. Collapsing alae should be treated by nasal reconstruction, with removal of the obstruction and stabilization of the nasal framework. In children, it has been possible to enhance symmetric growth, and at times, increase growth-potentials by re-alignment of the cartilaginous structures of the nose.

Topics: Airway Obstruction; Cartilage; Child; Congenital Abnormalities; Female; Humans; Infant, Newborn; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Diseases; Rhinoplasty

The introduction of some new physical methods has considerably improved the writer's treatment of asthmatic children. These methods include an endeavour to attain nasal breathing, together with slow, deep "sleep breathing", and a system of eight or ten physiotherapy exercises which are described in detail. Since their adoption the consumption of aerosol bronchodilators has fallen dramatically.

Topics: Airway Obstruction; Asthma; Breathing Exercises; Child; Child, Preschool; Hospitalization; Humans; Metaproterenol; Nose; Physical Therapy Modalities; Private Practice; Sleep

Nasal problems in children are very common. The factors that affect the embryologic development have been discussed. Injuries that occur in prenatal, natal, and postnatal periods affect normal development. Prompt treatment of minor injuries is necessary to prevent airway problems later. The "wait and see" attitude toward nasal deformity is ill advised. X-ray findings are not conclusive, as the nasal pyramid in a child is largely cartilaginous. Obstructive nasal breathing can result in facial asymmetry, malocclusion, and cardiopulmonary problems. Allergy and sinusitis are frequently causes of obstruction.

Topics: Acute Disease; Adolescent; Airway Obstruction; Birth Injuries; Cartilage; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Infant, Newborn; Male; Malocclusion; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Pregnancy; Sinusitis; Skull Fractures; Wounds, Nonpenetrating; Wounds, Penetrating

Topics: Aged; Airway Obstruction; Humans; Intubation, Gastrointestinal; Laryngeal Edema; Male; Nose; Time Factors

Topics: Airway Obstruction; Child; Fractures, Bone; Humans; Infant, Newborn; Nose; Nose Deformities, Acquired

Topics: Airway Obstruction; Animals; Animals, Newborn; Humans; Infant, Newborn; Muscles; Nose; Respiration; Sheep; Sleep

A technique is described for use of intranasal acrylic resin stents with finger springs and/or orthodontic jackscrew expanders for initiating and maintaining a desired amount of opening in the presence of scar tissue or grafts.

Topics: Acrylic Resins; Airway Obstruction; Cicatrix; Humans; Maxillofacial Prosthesis; Nasal Cavity; Nose; Prosthesis Design

Nasotracheal intubation can be used effectively for the relief of upper airway obstruction in diphtheria. It has many advantages over tracheostomy; it avoids an operation and it eases anxiety of the parents. Of 57 patients so treated, 50 recovered without injury to the larynx in any patient.

Topics: Airway Obstruction; Child; Diphtheria; Humans; Infant; Intubation, Intratracheal; Nose; Tracheotomy

Topics: Aerosols; Airway Obstruction; Assisted Circulation; Bronchoscopy; Child; Croup; Drainage; Emergencies; Epinephrine; Equipment and Supplies; Foreign Bodies; Humans; Intubation, Intratracheal; Laryngoscopy; Masks; Mouth; Nose; Respiration, Artificial

Topics: Adult; Airway Obstruction; Humans; Male; Nose; Nose Diseases; Permeability; Sports; Tunisia

Topics: Airway Obstruction; Cerebrospinal Fluid Rhinorrhea; Edema; Facial Injuries; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans; Maxillary Sinus; Methods; Nose; Orbit; Zygomatic Fractures

Topics: Acid-Base Equilibrium; Airway Obstruction; Animals; Bicarbonates; Dogs; Hydrogen-Ion Concentration; Nose

Topics: Airway Obstruction; Bronchoscopy; Child; Child, Preschool; Female; Granuloma; Humans; Intubation, Intratracheal; Laryngeal Edema; Male; Nose; Postoperative Complications; Tracheal Stenosis; Tracheotomy

Topics: Airway Obstruction; Anesthesia, General; Coma; Humans; Methods; Movement; Nose; Unconsciousness

Topics: Airway Obstruction; Animals; Disease Models, Animal; Dogs; Frontal Sinus; Microscopy, Electron; Mucocele; Nasal Mucosa; Nose; Osteotomy; Radiography; Sinusitis; Turbinates

Topics: Airway Obstruction; Humans; Nose; Turbinates

Topics: Adenoids; Adrenal Cortex Hormones; Airway Obstruction; Anti-Bacterial Agents; Child, Preschool; Foreign Bodies; Histamine H1 Antagonists; Humans; Hypersensitivity; Hypertrophy; Nasopharyngeal Diseases; Nose; Nose Deformities, Acquired; Nose Diseases; Otitis; Rhinitis; Sympathomimetics

Topics: Airway Obstruction; Apnea; Death, Sudden; Humans; Infant; Infant, Newborn; Nose; Reflex; Respiration; Sleep, REM

Topics: Adolescent; Adult; Aged; Airway Obstruction; Burns; Child; Child, Preschool; Ear; Eye Burns; Facial Injuries; Female; Humans; Infant; Lung Injury; Male; Middle Aged; Neck Injuries; Nose; Scalp; Skin Transplantation; Surgery, Plastic; Transplantation, Heterologous; Transplantation, Homologous; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Airway Obstruction; Anesthesia, Intravenous; Carcinoma, Squamous Cell; Cough; Epistaxis; Female; Fracture Fixation, Internal; Fractures, Bone; Hemorrhage; Humans; Ketamine; Male; Mandibular Neoplasms; Nose; Orthopedic Fixation Devices; Pharynx; Reflex; Surgery, Oral

Topics: Airway Obstruction; Humans; Intubation; Micrognathism; Nose; Stomach; Time Factors

Topics: Airway Obstruction; Humans; Manometry; Nasopharynx; Nose; Respiratory Function Tests

Topics: Adenoids; Airway Obstruction; Ephedrine; Foreign Bodies; Hematoma; Histamine H1 Antagonists; Humans; Hypersensitivity; Hypertrophy; Mucus; Nasal Polyps; Nasal Septum; Nose; Nose Diseases; Nose Neoplasms; Rhinitis

Topics: Accidents, Traffic; Adult; Airway Obstruction; Child; Child, Preschool; Facial Injuries; Fracture Fixation; Fractures, Bone; Humans; Intubation, Intratracheal; Male; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Orbit; Tracheotomy; Zygomatic Fractures

Topics: Adult; Airway Obstruction; Dental Occlusion; Diplopia; Female; Functional Laterality; Hemiplegia; Humans; Jaw Fractures; Male; Mandibular Fractures; Maxillary Fractures; Nose; Palpation; Radiography; Shock, Hemorrhagic; Zygomatic Fractures

Topics: Adolescent; Airway Obstruction; Child; Child, Preschool; Female; Humans; Infant; Intubation, Intratracheal; Male; Nose

Topics: Airway Obstruction; Blood Transfusion; Debridement; Ear; Facial Injuries; Fracture Fixation; Humans; Male; Mandibular Fractures; Maxillary Fractures; Maxillofacial Injuries; Nose; Orbit; Radiography; Shock, Traumatic; Skin Transplantation; Tracheotomy; Transplantation, Autologous; Wound Healing

Topics: Airway Obstruction; Enteral Nutrition; Esophagus; Female; Humans; Infant, Newborn; Intubation; Intubation, Gastrointestinal; Nose; Pharynx; Pierre Robin Syndrome; Pressure; Time Factors

Topics: Adult; Airway Obstruction; Airway Resistance; Anesthesia, General; Bronchi; Cilia; Cough; Deglutition; Female; Gagging; Glottis; Humans; Intubation, Intratracheal; Larynx; Male; Middle Aged; Nasopharynx; Nose; Pharynx; Reflex; Respiration; Respiratory System; Trachea; Tracheotomy

Topics: Air Conditioning; Airway Obstruction; Body Temperature Regulation; Deglutition; Intubation, Intratracheal; Larynx; Methods; Nose; Postoperative Care; Postoperative Complications; Pulmonary Ventilation; Speech; Trachea; Tracheal Stenosis; Tracheotomy

Topics: Airway Obstruction; Airway Resistance; Animals; Body Weight; Cicatrix; Dogs; Intubation, Intratracheal; Lung Compliance; Mouth Breathing; Nose; Plethysmography, Whole Body; Pressure; Pulmonary Ventilation; Respiration; Respiratory Function Tests; Spirometry

Topics: Airway Obstruction; Child, Preschool; Humans; Infant; Larynx; Nose; Respiratory Tract Infections; Trachea

Topics: Airway Obstruction; Anti-Infective Agents; Cautery; Electrocoagulation; Humans; Methods; Nasal Septum; Nose; Nose Diseases; Rhinitis; Rhinitis, Atrophic; Rhinoplasty; Sclerosing Solutions; Turbinates

Topics: Airway Obstruction; Anesthesia, Local; Humans; Methods; Nasal Mucosa; Nose; Nose Deformities, Acquired; Respiration; Turbinates

Topics: Aging; Airway Obstruction; Biomedical Research; Equipment and Supplies; Humans; Mouth; Nasal Septum; Nose; Nose Deformities, Acquired; Respiration; Respiratory Function Tests; Surgical Procedures, Operative

Topics: Airway Obstruction; Humans; Nasal Septum; Nose; Nose Deformities, Acquired; Respiratory Function Tests; Respiratory Insufficiency; Respiratory Tract Diseases

Topics: Airway Obstruction; Constriction, Pathologic; Female; Humans; Nasopharyngeal Diseases; Nose; Nose Diseases; Polyhydramnios; Pregnancy

Topics: Aged; Airway Obstruction; Constriction, Pathologic; Humans; Nasopharynx; Nose; Pharyngeal Diseases

Topics: Airway Obstruction; Animals; Dogs; Nose; Nose Diseases

Topics: Airway Obstruction; Humans; Nose; Ventilators, Mechanical