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Congenital arhinia - First published case in Malaysia

Ng RL, Rajapathy K, Ishak Z

Med J Malaysia, 2017 10;72(5):308-310.
PMID: 29197888 MyJurnal

Congenital arhinia is one of the rare craniofacial malformation that may cause severe respiratory distress at birth due to upper airway obstruction. Our patient, whose abnormalities were only detected after delivery in our centre, is the first reported case of congenital arhinia in Malaysia. Contrary to popular belief that neonates are obligate nasal breather, our patient adapted well to breathing through mouth before an elective tracheostomy was performed on day four of life.

Matched MeSH terms: Nose/physiopathology
Image of the month: Discolouration leading to black eschar over the nose. Invasive fungal sinusitis (IFS)

Idris N, Lim LH

J Paediatr Child Health, 2010 Dec;46(12):779, 789.
PMID: 21166919 DOI: 10.1111/j.1440-1754.2010.02002-2.x
Matched MeSH terms: Nose/physiopathology*
Nasal Peak Inspiratory Flow in Healthy and Obstructed Patients: Systematic Review and Meta-Analysis

Mo S, Gupta SS, Stroud A, Strazdins E, Hamizan AW, Rimmer J, et al.

Laryngoscope, 2021 02;131(2):260-267.
PMID: 32386248 DOI: 10.1002/lary.28682

OBJECTIVES: Nasal peak inspiratory flow (NPIF) is a practical and affordable tool that measures maximum inspiratory flow rate through both nostrils. Although NPIF values for healthy controls and patients appear to differ considerably, a generally expected value for populations with and without nasal obstruction has yet to be established. The aim of this systematic review and meta-analysis was to determine the mean NPIF value in populations with and without nasal obstruction.
METHODS: Medline (1946-) and Embase (1947-) were searched until July 1, 2017. A search strategy was used to identify studies that reported NPIF values for defined healthy or disease states. All studies providing original data were included. The study population was defined as having either normal nasal breathing or nasal obstruction. A meta-analysis of the mean data was presented in forest plots, and data were presented as mean (95% confidence interval [CI]).
RESULTS: The search yielded 1,526 studies, of which 29 were included. The included studies involved 1,634 subjects with normal nasal breathing and 817 subjects with nasal obstruction. The mean NPIF value for populations with normal nasal breathing was 138.4 (95% CI: 127.9-148.8) L/min. The mean value for populations with nasal obstruction was 97.5 (95% CI: 86.1-108.8) L/min.
CONCLUSIONS: Current evidence confirms a difference between mean NPIF values of populations with and without nasal obstruction. The mean value of subjects with no nasal obstruction is 138.4 L/min, and the mean value of nasally obstructed populations is 97.5 L/min. Prospective studies adopting a standardized procedure are required to further assess normative NPIF values. Laryngoscope, 131:260-267, 2021.

Matched MeSH terms: Nose/physiopathology*
Fulltext Integrating the Divided Nasal Cannula Into Routine Polysomnography to Assess Nasal Cycle: Feasibility and Effect on Outcomes

Scapuccin M, Schneider L, Rashid N, Zaghi S, Rosa T, Tsou YA, et al.

J Clin Sleep Med, 2018 04 15;14(4):641-650.
PMID: 29609709 DOI: 10.5664/jcsm.7062

STUDY OBJECTIVES: Patients suspected to have sleep-disordered breathing underwent an overnight polysomnography using a divided nasal cannula to gain additional information about the nasal cycle during sleep.
METHODS: This was a prospective, observational cohort study replacing the undivided nasal cannula with a divided nasal cannula during routine polysomnography (n = 28).
RESULTS: Integration of the divided nasal cannula pressure transducer system into routine polysomnography was easy and affordable. Most patients (89%) demonstrated nasal cycle changes during the test. Nasal cycle changes tended to occur during body position changes (62%) and transitions from non-rapid eye movement sleep to rapid eye movement sleep (41%). The mean nasal cycle duration was 2.5 ± 2.1 hours. Other sleep study metrics did not reveal statistically significant findings in relation to the nasal cycle.
CONCLUSIONS: Replacing an undivided nasal cannula with a divided nasal cannula is easy to implement, adding another physiologic measure to polysomnography. Although the divided nasal cannula did not significantly affect traditional polysomnographic metrics such as the apnea-hypopnea index or periodic limb movement index based on this small pilot study, we were able to replicate past nasal cycle findings that may be of interest to sleep clinicians and researchers. Given the ease with which the divided nasal cannula can be integrated, we encourage other sleep researchers to investigate the utility of using a divided nasal cannula during polysomnography.

Matched MeSH terms: Nose/physiopathology
Objective assessment of nasal resistance in patients with nasal disease

Suzina AH, Hamzah M, Samsudin AR

J Laryngol Otol, 2003 Aug;117(8):609-13.
PMID: 12956914

Nasal obstruction is a subjective complaint in patients with nasal disease. The ability to quantitate the nasal ventilation dysfunction would be useful for making the appropriate choice of nasal disease management. This cross-sectional study comprised of 200 adult subjects. They underwent assessment of relevant symptoms, nasal examination and investigations before undergoing active anterior rhinomanometry (AAR) assessment. A group of 88 normal subjects and 112 patients with nasal disease were included. The mean total nasal air resistance (NAR) was significantly higher in patients with nasal disease (0.33 Pa/cm(3)/s) as compared to normal subjects (0.24 Pa/cm(3)/s). There was no significant difference in total NAR between patients with symptoms of nasal obstruction and those without the symptoms (p = 0.42). It is concluded that AAR is a sensitive but not a specific tool for the detection of abnormalities in NAR and it failed to relate to the symptom of nasal obstruction.

Matched MeSH terms: Nose/physiopathology
Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison

Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J

Eur J Orthod, 2005 Feb;27(1):91-7.
PMID: 15743868

The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe OSA; Indian n = 11, which included six mild and five moderate-severe OSA; and Chinese n = 12, which included six mild and six moderate-severe OSA) diagnosed using overnight polysomnography. After use of a decongestant, NRR was recorded using anterior and posterior rhinomanometry. Standardized lateral cephalometric radiographs were used to record linear and angular dimensions. Malay subjects with moderate-severe OSA had a shorter maxillary (sp-pm) and mandibular (gn-go) length when compared with a mild OSA reference sample (P < 0.05). The hyoid bone was located more caudally in the Chinese moderate-severe subjects (hy-NL, hy-ML)(P < 0.05), and may be a useful diagnostic indicator for severity in this racial group. No pattern of differences for NRR was seen between the moderate-severe and mild OSA subjects. The consistently lower values for nasopharyngeal resistance in all the moderate-severe subjects when compared with the mild group may indicate that some compensation at this level of the airway had taken place. Strong positive correlations between craniocervical angulation (NL/OPT) and total airway resistance and the turbulent component of flow (k(2)) suggest that head posture is sensitive to fluctuations in airway resistance (P < 0.01).

Matched MeSH terms: Nose/physiopathology*