RHINOMANOMETRY IN THE ANALYSIS OF STENOSI S IN THE NASAL VESTIBULE - BACKGROUND

The distinction of the resistance in the nasal vestibule (valve area) and cavity (turbinates, septum deviations, crest, spine) is important for the settlement of the operative course in nasally impaired patient s. Collapsed valves, free floating polyps, spines, and other turbulenc e producing factors in the nose are characterized in active anterior r hinomanometry (AAR) as decreased ''percentage of flow increase'' (Delt a V-150-300). This parameter allows no distinction between underlying anatomical factors. Other patients have increased resistance in the ve stibule area that is static; rhinomanometry is unable to document thes e instances. The aim of this study was to investigate the influence of the vestibule dilator on nasal flow, and to determine if the diagnost ic findings of AAR could be improved by the data obtained from the mea surement with the dilator. Methods: To prove the influence of the vest ibule dilator on the nasal airflow, we determined typical rhinomanomet ric parameters in 20 nasally healthy and 40 nasally impaired persons w ith and without the dilator. For the measurements, we used a computer- aided rhinomanometer (Rhinodat K-(R), Heinemann Medizintechnik, D-Hamb urg). Tubular vestibule dilators were produced from silicon guide rail s of tracheal tubes (Ruschelit((R)), Fa. Rusch, D-Kernen) and individu ally adapted to the patient's vestibule, ensuring dilatation between t he external ostium and the nasal isthmus. Results: Active anterior rhi nomanometry revealed a significant effect of the vestibule dilator in repeated application (mean variation 3%). Total nasal flow showed a me an increase of about: 48% with the dilator. In AAR, we found 5 patient s with decreased Delta V-150-300 below 25%. To demonstrate the presenc e of a vestibule stenosis, we compared the changes of Delta V-150-300 in AAR with and without dilator. In rhinomanometry with the dilator, D elta V-150-300 of patients with vestibule stenosis showed physiologica l values. In these patients, mean difference of Delta V-150-300 betwee n conventional rhinomanometry and rhinomanometry with a vestibule dila tor was significantly higher (47,2%) than observed in all other person s (3,8%). The static vestibule resistance in the total nasal resistanc e was obtained by calculating the difference between the nasal flows w ith and without the dilator. Conclusions: Stenosis in the nasal vestib ule could be proved and measured via active anterior rhinomanometry us ing a vestibule dilator. Data obtained from this method are helpful in functional assessment of nasally impaired patients, particularly to a nswer the question of whether the vestibule requires surgical treatmen t.