New Measurement Methods in the Diagnostic of Nasal Obstruction
Rhinomanometry is currently being used throughout the world for the objective measurement of nasal obstruction. This method enables objectification of the extent of nasal obstruction, but does not permit differentiation between the four various causes of
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Gunter H. Mlynski
Keywords
Rhinomanometry • Rhinoresistometry • Acoustic rhinometry • Long-term rhinoflowmetry • Extent of nasal obstruction • Objectification of obstruction causes • Nasal diffuser • Preoperative management • Postoperative quality control
Core Messages
• Accurate preoperative analysis of the extent and cause of nasal breathing complaints in combination with a stronger physiological perspective in surgical therapy is needed if we are to make progress beyond unsatisfactory long-term outcomes with inadequate improvement in nasal airway obstruction and frequent postoperative sicca symptoms. • New measurement methods need to be developed to objectify nasal obstruction, since rhinomanometry is only capable of adequately differentiating the degree of obstruction, but not its causes. • Rhinoresistometry, a refinement of rhinomanometry, makes it possible to
G.H. Mlynski, PhD Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Walter-Rathenaustr. 43–45, Greifswald, D-17475, Germany Alte Dorfstr. 25, Stolpe auf Usedom, BRD, D-17406, Germany e-mail: [email protected]
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objectively determine not only the degree of obstruction but also swelling, skeletal stenosis, inspiratory collapse of the nasal valves, and pathological turbulence as possible causes of nasal obstruction. By combining rhinoresistometry with acoustic rhinometry, it is possible to accurately localize skeletal stenoses and determine the causes of pathological turbulence. Rhinoresistometry and acoustic rhinometry only enable the objective measurement of conditions in the nose at the time of measurement. Long-term rhinoflowmetry has been developed to overcome this limitation. Long-term rhinoflowmetry yields information about the nasal cycle in specific conditions and provides an objective measurement of reactive congestion over a 24-h period under the usual conditions of the patient’s everyday life. New techniques for the diagnostic evaluation of nasal obstruction make it possible to set better surgical indications
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_27, © Springer-Verlag Berlin Heidelberg 2013
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G.H. Mlynski
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prior to functional nasal surgical interventions and to better plan the surgery. • Rhinoresistometry, acoustic rhinometry, and long-term rhinoresistometry now offer the practitioner tools that allow essential postoperative quality control in functional nasal surgery.
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Preliminary Remarks
Despite a number of significant advances in recent decades in the area of procedures for the diagnostic evaluation of nasal obstruction, there has been a striking failure until now to implement routine objective preoperative diagnostic testing prior to functional and aesthetic nasal surgery or postoperative quality control. Rhinomanometry (RMM) is currently being used throughout the world for the objective measurement of nasal obstruction (Clement and Gordts 2005). This procedure measures nasal airflow at a given pressure
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