Acoustic rhinometry (AR) is a recently developed objective technique for assessment of geometry of the nasal cavity. The technique is based on the analysis of sound waves reflected from the nasal cavities. It measures cross-sectional areas and nasal volume (NV). To obtain dependable assessments of nasal resistance by rhinomanometry or cross-sectional area measurements by AR, it is essential that the structural relations of the compliant vestibular region remain undisturbed by the measuring apparatus. The use of nozzles in making these measurements carries a great risk of direct distortion of the nasal valve. We used a nasal adapter that does not invade the nasal cavity and a chin support that stabilizes the head. In 51 healthy nasal cavities, the average minimum cross-sectional area (MCA) was 0.62 cm2 at 2.35 cm from the nostril and 0.67 cm2 at 2 cm from the nostril, respectively, before and after topical decongestion of the nasal mucosa. The MCA and NV findings in this group were significantly higher than MCA and NV (P < 0.001) in people with structural or mucosal abnormalities before mucosal decongestion. After mucosal decongestion, the MCA and NV were significantly higher in healthy nasal cavities than in nasal cavities with structural abnormalities (P < 0.001) but were not higher than nasal cavities with mucosal abnormalities (MCA, P = 0.05; NV, P = 0.06). A nozzle was applied in 20 healthy nasal cavities after mucosal decongestion, and a significantly higher MCA was found compared to measurements made with the nasal adapter (P = 0.02). We conclude that the nasal adapter, which does not invade the nasal cavities, avoids the distortion of the nasal valve and gives more accurate results.

Warthin's tumor is controversial. This controversy is multifaceted and relates to all aspects of the tumor from its historical beginnings to its pathogenesis, investigations, and treatments. In this paper, an in depth study of Warthin's tumor has been made to help clarify these controversies.

The aims of this study are to assess nasal valve cross-sectional areas in healthy noses and in patients with nasal obstruction after rhinoplasty and to evaluate the effect of an external nasal dilator on both healthy and obstructive nasal valves. Subjects consisted of (i) volunteers with no nasal symptoms, nasal cavities unremarkable to rhinoscopy and normal nasal resistance and (ii) patients referred to our clinic complaining of postrhinoplasty nasal obstruction. All subjects were tested before and after topical decongestion of the nasal mucosa and with an external nasal dilator. In 79 untreated healthy nasal cavities the nasal valve area showed two constrictions: the proximal constriction averaged 0.78 cm2 cross-section and was situated 1.18 cm from the nostril, the distal constriction averaged 0.70 cm2 cross-section at 2.86 cm from the nostril. Mucosal decongestion increased cross-sectional area of the distal constriction significantly (p < 0.0001) but not the proximal. External dilation increased cross-sectional area of both constrictions significantly (p < 0.0001). In 26 post-rhinoplasty obstructed nasal cavities, only a single constriction was detected, averaging 0.34 cm2 cross-section at 2.55 cm from the nostril and 0.4 cm2 at 2.46 cm from the nostril, before and after mucosal decongestion respectively. External dilation increased the minimum cross-sectional area to 0.64 cm2 in these nasal cavities (p < 0.0001). We conclude that the nasal valve area in patients with postrhinoplasty nasal obstruction is significantly smaller than in healthy nasal cavities as shown by acoustic rhinometry. Acoustic rhinometry objectively determines the structural and mucovascular components of the nasal valve area and external dilation is an effective therapeutical approach in the management of nasal valve obstruction.

The reproducibility of nasal patency measurements was assessed by acoustic rhinometry and active rhinomanometry using previously described Toronto methodologies. Six subjects with normal upper airways were tested with both procedures on six separate occasions within a 2-month period. Topical decongestant was applied to minimize the effects of mucosal variation on the nasal airway. The mean coefficients of variation (mean +/- s.d; %) over time of the measurements were 8.1 +/- 4.1 and 9.7 +/- 5.2 for minimal unilateral cross-sectional area and 4.8 +/- 1.8 and 5.5 +/- 3.5 for nasal volume (0-5 cm) of the right and left sides, respectively. For active rhinomanometry, the mean coefficients of variation (mean +/- s.d.; %) over time of the measurements were 15.9 +/- 7.3, 12.9 +/- 4.6, and 8.5 +/- 2.8 for right, left and combined nasal airflow resistance. The intraclass correlation coefficient was 0.76, 0.70, and 0.96 for right, left, and combined nasal resistance, 0.91 and 0.87 for right and left minimal cross sectional area, and 0.86 and 0.69 for right and left nasal volumes, respectively, also confirming a high level of reproducibility for both methods. In conclusion, performed by an experienced operator under controlled circumstances, the reproducibility of both methods of nasal patency assessment compared favorably with many widely accepted clinical tests.

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.

Nasal nitric oxide (NO), a powerful vasodilator, could control the filling of nasal capacitance vessels, thus determining nasal patency and mediating the acute congestion accompanying allergen challenge. We examined the effect of topical N-nitro-L-arginine-methyl-ester (L-NAME; 100 to 200 mg), an NO synthase inhibitor, on nasal NO and on nasal patency assessed by acoustic rhinometry in 7 subjects with nasal allergy, and in 4 subjects we examined the effects of nasal allergen challenge on nasal NO before and after a short course of nasal steroid. After L-NAME, nasal NO fell to 42.1%+/-15.7% of baseline (p < .0001) with no significant change in minimal cross-sectional area. After allergen challenge, acute congestion was associated with a significant fall in nasal NO, which returned to baseline by 4 hours, when the congestion resolved. Repeat challenge after 2 weeks of nasal corticosteroid yielded similar findings. A role for NO in modulating vascular tone was not supported by the present study.

The feasibility of using aerosol vaccines to achieve mass and rapid immunization, especially in developing countries and disaster areas, is being assessed on the basis of current available information. The aerosol mode of vaccine introduction, which best follows the natural route of many infections, may first lead to development of immunity at the portal of entry, and may also induce a more generalized defense. The recommended optimal way of introducing an aerosol vaccine is nasal breathing, which is more suitable for geriatric and pediatric populations, permits use of greater antigen volumes, and allows easier monitoring of results. Technical requirements for ideal aerosol vaccines and delivery systems, possible adverse effects, and cost-effectiveness are other issues addressed. Several thousand human subjects have been aerosol-vaccinated over a period of many years in Russia with live-attenuated strains against many diseases. Extensive field trials in South America with aerosolized live-attenuated measles vaccine have also been successful, and excellent results have been reported with pilot projects employing inactivated or live-attenuated aerosol influenza A vaccine. We conclude that aerosol immunization seems a promising method of vaccination. Although some basic information is still lacking, this method has already been used successfully in large populations and has therefore passed the phase of initial feasibility evaluation.

Geometric changes of the nasal airway in response to allergen challenge were measured by acoustic rhinometry (AR) and the sensitivity of the method was compared with that of rhinomanometry. Ten asymptomatic patients who suffered from ragweed allergic rhinitis were challenged out of season. The use of a custom-made noninvasive nasal adapter was an important feature of the measurement technique. A dose-dependent decrease in nasal cross-sectional area was found at and posterior to the entrance to the nasal valve. Both rhinometric and rhinomanometric methods were equivalent in sensing the changes in nasal patency due to allergen exposure (p=0.73). Acoustic rhinometry, however, was simpler, more quickly performed and more comfortable for the subjects than was rhinomanometry by body plethysmography. AR is an alternative objective method for measurement of nasal mucosal responses, as in allergen challenge.