Correlations Between Acoustic Rhinometry, Subjective Symptoms, and Endoscopic Findings in Symptomatic Children With Nasal Obstruction

Isaac, André; Major, Michael P.; Witmans, Manisha; Alrajhi, Yaser; Flores-Mir, Carlos; Major, Paul W.; Alsufyani, Noura; Korayem, M.; El‐Hakim, Hamdy

doi:10.1001/jamaoto.2015.0468

Cited by 45 publications

(29 citation statements)

References 30 publications

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“…A study that evaluated NO in children using nasal endoscopy, AcR, and VAS did not detect any significant correlation between the techniques, while a weak correlation was found between endoscopic findings (unilateral, bilateral, or absent obstruction) and VAS [34].…”

Section: How Subjective Methods and Objective Methods Are Correlatedmentioning

confidence: 88%

“…It may be anterior (when the measurement systems are placed at the level of the nasal nostril) or posterior (requires the placement of an intra-oral device to register choanal pressure). Both modalities can be active (the subject breathes actively or spontaneously) or passive (the subject is in apnea and a predetermined airflow is propelled through the The VAS is a well-studied tool for assessing the severity of NO and has been validated with reference to other subjective measures such as symptom score [31] and to objective measures such as rhinomanometry (RMN), acoustic rhinometry (AcR), and peak nasal inspiratory flow (PNIF) in adults [32,33] and nasal endoscopy in children [34]. It has been estimated that, in asymptomatic individuals, the mean VAS value used to assess NO ranges from 2.1 (2.2) to 4.6 (2.6) in the general population [23].…”

Section: Objective Evaluationmentioning

confidence: 99%

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Position Paper on Nasal Obstruction: Evaluation and Treatment

Valero

Navarro²,

Cuvillo³

et al. 2018

J Investig Allergol Clin Immunol

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Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

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Section: How Subjective Methods and Objective Methods Are Correlatedmentioning

confidence: 88%

Section: Objective Evaluationmentioning

confidence: 99%

Position Paper on Nasal Obstruction: Evaluation and Treatment

Valero

Navarro²,

Cuvillo³

et al. 2018

J Investig Allergol Clin Immunol

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“…The emphasis of this system is to guide the decision to operate rather than merely assign a grade and it had been validated in a previous study (K = 0.83 [0.69–0.98]) [13]. The endoscopic rhinitis score (ERS) is a system to grade the degree of chronic rhinitis using nasal endoscopy which has shown good intra-rater and inter-rater reliability in a previous study [14]. Other reported variables include the degree of deviated nasal septum (DNS), obstructive adenoids [14], presence or absence of nasal polyps, tonsillar obstruction, pharyngeal collapse (lateral wall, antero-posterior, or circumferential), lingual tonsil hypertrophy, and laryngeal findings (laryngomalacia (LM), cleft, stenosis, paralysis).…”

Section: Methodsmentioning

confidence: 99%

“…The endoscopic rhinitis score (ERS) is a system to grade the degree of chronic rhinitis using nasal endoscopy which has shown good intra-rater and inter-rater reliability in a previous study [14]. Other reported variables include the degree of deviated nasal septum (DNS), obstructive adenoids [14], presence or absence of nasal polyps, tonsillar obstruction, pharyngeal collapse (lateral wall, antero-posterior, or circumferential), lingual tonsil hypertrophy, and laryngeal findings (laryngomalacia (LM), cleft, stenosis, paralysis). It should be stressed that the tonsil size reported in this study was that identified at the time of DISE, (degree the tonsils obstruct the oropharyngeal airway during simulated sleep), rather than the office based scales.…”

Section: Methodsmentioning

confidence: 99%

Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing

Alsufyani

Isaac

Witmans

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundAdenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-induced sleep endoscopy (DISE) has the potential to individualize surgical treatments and avoid unnecessary or unsuccessful surgeries. The objective of this study was to determine the predictors of failure of DISE-directed adenoidectomy and/or tonsillectomy in otherwise healthy children with SDB.MethodsWe retrospectively reviewed a prospective database of children who presented with SDB. All patients underwent preoperative pulse oximetry (PO), followed by DISE with T ± A, The variables documented included demographics, ethnicity, co-morbidities, family history, McGill Oximetry Score (MOS) on PO, as well as findings of collapse and or obstruction on DISE and symptom resolution based on modified Pediatric Sleep Questionnaire (PSQ). The primary outcome was the independent predictors of treatment failure based on multivariate binary logistic regression.ResultsThree hundred eighty-two patients satisfied the inclusion criteria. Based on post-operative modified PSQ, SDB resolved in 259 patients (68%), whereas 123 (32%) had persistent symptoms. On bivariate analysis, neuropsychiatric diagnosis (r = 0.286, p = 0.042), history of sleepwalking or enuresis (r = 0.103, p = 0.044), MOS (r = 0.123, p = 0.033), presence of DNS (r = 0.107, p = 0.036), and presence of laryngomalacia (r = 0.122, p = 0.017) all positively correlated with treatment failure. Small tonsil size on DISE correlated with treatment failure (r = −0.180, p < 0.001). Multivariate analysis identified age greater than 7 years (OR = 1.799, [95% CI 1.040–3.139], p = 0.039), obesity (OR = 2.032, [95% CI 1.043–3.997], p = 0.040), chronic rhinitis (OR = 1.334, [95% CI 1.047–1.716], p = 0.025), deviated nasal septum (OR = 1.745, [95% CI 1.062–2.898], p = 0.031) and tonsil size (OR = 0.575, [95% CI 0.429–0.772], p < 0.01) as independent predictors of treatment failure.ConclusionsObese, asthmatic, and children older than seven years are at increased risk of treatment failure after DISE-directed AT. Several DISE findings can independently predict AT failure, including tonsil size, degree of chronic rhinitis, and the presence of a deviated nasal septum, and can be addressed at a second stage. Further research is needed into the role of DISE in surgically naïve patients with SDB, and to compare DISE-directed surgery with the current standard of care.

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“…However, they have not found a subjective connection with any other alteration such as asthma, septal deviation, enlarged adenoids or Obstructive Sleep Apnea Syndrome (OSAS), so it is important to assess the airway beyond the symptoms described by the patient (4,5) .…”

Section: Introductionmentioning

confidence: 99%

Evaluación de la Vía Aérea superior en Ortodoncia. Revisión Narrativa

Rojas

Corvalán

Messen

et al. 2017

Odontoestomatología

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Introduction: Upper airway assessment is particularly important in the daily work of orthodontists, pediatric dentists, ENT specialists, speech therapists, etc., because of its close connection with the development of craniofacial structures and with other pathologies such as Obstructive Sleep Apnea Syndrome (OSAS). Objective: To review the limits, functions and anomalies of different areas that make up the upper airway, to provide information about specific methods most widely used by specialists for their evaluation, and to describe and evaluate the information level and diagnostic accuracy of methods such as lateral cephalometric analysis and cone beam CT. Materials and Methods: The search was conducted on PubMed, with the following keywords: upper airway and CBCT, upper airway and assessment, evaluation and upper airway; upper airway and orthodontics. Only studies less than 5 years old were selected. A total of 46 papers were read and finally, 38 studios were selected. Conclusions: It is essential to know upper airway assessment methods, which include a clinical examination, a radiographic evaluation and CBCT. These will indicate possible functional changes that could interfere with treatment.

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Correlations Between Acoustic Rhinometry, Subjective Symptoms, and Endoscopic Findings in Symptomatic Children With Nasal Obstruction

Abstract: Among the evaluated tools, endoscopy appears to be the most reliable tool to estimate the degree of subjective nasal symptoms.

Cited by 45 publications

References 30 publications

Position Paper on Nasal Obstruction: Evaluation and Treatment

Position Paper on Nasal Obstruction: Evaluation and Treatment

Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing

Evaluación de la Vía Aérea superior en Ortodoncia. Revisión Narrativa

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