Download PDF
Facial Plast Surg 2024; 40(03): 314-322
DOI: 10.1055/a-2218-5883
Original Research

Measurement of Nasal Obstruction: Rhinomanometry as Basic Method in Functional Rhinology

Klaus Vogt
1   Faculty of Medicine, University of Latvia, Riga, Latvia
2   MedTecResearch, Krakow am See, Germany
,
Karen Parker-Davidson
3   School of Health Sciences, Central Michigan University, Mt. Pleasant, Michigan
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Measuring nasal obstruction should be mandatory before every nasal surgery to determine the necessary surgical steps and to separate mucosal congestion from skeletal deformity. Rhinomanometry is considered the “golden standard” for measuring nasal airway resistance. An extension of the diagnostic power was achieved by the introduction of the four-phase rhinomanometry (4PR), which provides additional information about the influence of the elasticity of the nasal wall. Also, a high correlation to the subjective sensing of obstruction could be achieved by the introduction of logarithmic parameters. The parameters of 4PR could be classified by evaluating 36,500 measurements. The International Standardization Committee on the Objective Assessment of the Upper Airway (ISCOANA) determined it as the new standard. Adding a visual analog scale (VAS) to every measurement is a documentation of the feeling of obstruction at the moment of measurement. Practical hints for 4PR are given. The determination of obstruction for both nasal sides or the calculation of the total nasal resistance should be followed by a second analysis of the detailed obstruction anatomy. In the future, pressure losses or temperature gradients can be determined by computational fluid dynamics (CFD). A reliable way to simulate the success of single surgical steps with a high didactical meaning is the three-dimensional (3D) print of sliced nose models and to measure the effect of stepwise mechanical corrections.

Keywords

nasal obstruction - rhinomanometry - CFD simulation - 3D models


Publication History

Accepted Manuscript online:
28 November 2023

Article published online:
15 January 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Vogt K, Bachmann-Harildstad G, Lintermann A, Nechyporenko A, Peters F, Wernecke KD. The new agreement of the international RIGA consensus conference on nasal airway function tests. Rhinology 2018; 56 (02) 133-143
    CrossrefPubMedGoogle Scholar
  • 2 Vogt K, Jalowyski A. et al. 4 phase-rhinomanometry. Basics and practice 2010. Rhinology Suppl 2010; 21: 1-50
    PubMedGoogle Scholar
  • 3 Davidson KP. Breathe through Your Nose, Don't Pay through It: The Impact the Healthcare Industry Has on Nasal Function and How We Breathe. Gambrills, MD, USA: Peedee Publications; 2023
    Google Scholar
  • 4 Vogt K, Klaus-D W, Behrbohm H, Gubisch W, Argale M. Four-phase rhinomanometry: a multicentric retrospective analysis of 36,563 clinical measurements. Eur Arch Otorhinolaryngol 2016; 273 (05) 1185-1198
    CrossrefPubMedGoogle Scholar
  • 5 Vogt K, Wernecke K-D, Argale M, Kaulina K. Classification of total nasal obstruction in 10,033 cases by 4-phase–rhinomanometry. Romanian Journal of Rhinology 2016; 6 (23) 149-160
    CrossrefPubMedGoogle Scholar
  • 6 Peksis K, Unger J, Paulauska S. et al. Relationships among nasal resistance, age and anthropometric parameters of the nose during growth. Rhinol Online 2018; 1: 112-121
    CrossrefPubMedGoogle Scholar
  • 7 Peksis K, Unger J, Santa Paulauska AE, Blumbergs M, Vogt K, Wernecke K-D. Relationships among nasal resistance, age and anthropometric parameters of the nose during growth. Rhinol Online 2018; 1: 112-121
    CrossrefPubMedGoogle Scholar
  • 8 Akmenkalne L, Prill M, Vogt K. Nasal valve elastography: quantitative determination of the mobility of the nasal valve. Rhinol Online 2019; 2: 81-86
    CrossrefPubMedGoogle Scholar
  • 9 Gagnieur P, Fieux M, Louis B, Béquignon E, Bartier S, Vertu-Ciolino D. Objective diagnosis of internal nasal valve collapse by four-phase rhinomanometry. Laryngoscope Investig Otolaryngol 2022; 7 (02) 388-394
    CrossrefPubMedGoogle Scholar
  • 10 Ma Y, Yu M, Gao X. The effect of gradually increased mandibular advancement on the efficacy of an oral appliance in the treatment of obstructive sleep apnea. J Clin Sleep Med 2020; 16 (08) 1369-1376
    CrossrefPubMedGoogle Scholar
  • 11 Viksne R. Reproducibility and correlations of 4-phase-rhinomanometry and PNIF-tests [Diploma work]. Riga: University of Latvia; 2016
    Google Scholar
  • 12 Waldmann M, Grosch A, Witzler C. et al. An effective simulation- and measurement-based workflow for enhanced diagnostics in rhinology. Med Biol Eng Comput 2022; 60 (02) 365-391
    CrossrefPubMedGoogle Scholar