Humming‐induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study

Maniscalco, Mauro; Miceli, Sofia; Weitzberg, Eddie; Laurentiis, Guglielmo de; Stanziola, Anna Agnese; Rossillo, V; Lundberg, Jon O.

doi:10.1111/j.1365-2362.2004.01384.x

Cited by 45 publications

(58 citation statements)

References 36 publications

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“…This effect was related to the fast gas exchange between sinuses and nose induced by the sounding airflow, which in turn makes sinuses to behave like a kind of Helmholz resonator. Consistently, in both experimental models and in vivo settings, sinus ostium and the natural sinus frequency were the most important factors affecting the great amount of NO released during humming [55,119]. Interestingly, by introducing repeated humming manoeuvres immediately before measurements, NO levels assessed during silent exhalation were reduced, as was the intra-individual variation.…”

Section: Hummingmentioning

confidence: 56%

“…However, no study reported the prevalence of rhinosinusitis in the studied subjects. Noticeably, in a recent study excluding sinus diseases, allergic rhinitis was associated with higher nasal NO levels, when compared to normal controls [55].…”

Section: Allergic Rhinitismentioning

confidence: 99%

“…4). In addition, the humming peak was lost or markedly reduced in patients with allergic rhinitis, presenting endoscopic signs suggestive of sinus obstruction [55] Conclusions NO can significantly influence a variety of physiological and pathophysiological processes in the upper airways. Nasal NO may have important local as well as distal effects implicated, for example, in host defense and regulation of pulmonary function.…”

Section: Hummingmentioning

confidence: 99%

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Nitric oxide in upper airways inflammatory diseases

2007

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In the human respiratory tract, the main production sites of exhaled nitric oxide (NO) are the nose and paranasal sinuses. In the upper airways, NO has been suggested to be involved at different levels with regulatory, protective, defensive or deleterious effects. Therefore, we review some aspects of the origin, metabolism, and functions of NO in the upper airways, together with the role of NO in some upper airways inflammatory diseases. Furthermore, we discuss the recent improvements in nasal NO measurements, which may be useful to better characterize the involvement of the NO produced by nose and paranasal sinuses in upper airways inflammatory diseases such as allergic rhinitis, nasal polyposis, sinusitis, primary ciliary dyskinesia, and cystic fibrosis.

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Section: Hummingmentioning

confidence: 56%

Section: Allergic Rhinitismentioning

confidence: 99%

Section: Hummingmentioning

confidence: 99%

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Nitric oxide in upper airways inflammatory diseases

2007

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“…Various studies on nasal nitric oxide (nNO) in humans have revealed nitric oxide to be maximally produced from the nasal and paranasal sinus [11][12][13]. There have been also interesting analysis of humming and increased nNO as compared with normal quiet nasal exhalation suggesting improved paranasal sinus ventilation with this maneuver [14,15]. Humming causes the air to oscillate, which in turn seems to increase the exchange of air between the sinuses and the nasal cavity.…”

Section: Discussionmentioning

confidence: 99%

Nasal Breathing Exercise and its Effect on Symptoms of Allergic Rhinitis

Nair

2011

Indian J Otolaryngol Head Neck Surg

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Allergic rhinitis (AR) is a common and chronic health problem with a high prevalence and a significant effect on the health care expenditure. Intranasal steroid spray is recommended as the first line therapy for patients with moderate to severe AR. Our study clinically analysed the use of nasal breathing exercise (NBE) as an adjunct to intranasal steroid spray as a cheap and effective mode of management of AR. A 3 month, parallel, randomized study was carried out in a zonal and tertiary care referral center. In this study, participants (N = 60) with symptomatic AR were administered either a intranasal steroid spray fluticasone propionate (group A) or fluticasone propionate nasal spray and NBE (group B). Participants assessed their symptom severity daily over the 3 month treatment period. The mean total nasal symptom scores were lower in both the groups (5.1 vs. 3.8333 for group A and 5.2 vs. 2.6777 for group B) and the difference was statistically significant (P \ 0.05). The patients showed a definite improvement in overall and individual symptoms for both groups with significantly greater reduction in individual symptoms in the group B (P \ 0.05). In our study we have found that both treatments provided clinically meaningful responses, but the overall results favored fluticasone propionate and the NBE group. Hence NBE is a simple and cost effective measure to reduce symptoms of AR and improve patient satisfaction.

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“…Since this response is often blunted in pan-sinusitis and/or polyposis, it has been proposed as a non-invasive index of OMC patency, and hence a screening test for severity of rhinosinusitis [28,29]. This maneuver has been well-documented, methodologically, with respect to the effects of sampling mode, humming frequency, and nNO depletion by repeated sampling ("washout") [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

The Nasal Nitric Oxide Response to External Acoustic Energy: A Pilot Study of Sampling Dynamics

Shusterman

2015

Sinusitis

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Background: The paranasal sinuses serve as a reservoir of nitric oxide (NO), contributing to baseline nasal NO (nNO) levels. nNO has also been shown to increase transiently with humming, a response that may be blunted in severe rhinosinusitis. Blunting of the acoustically-induced nNO transient ("spike") has been proposed as a screening test for osteomeatal complex (OMC) obstruction in sinusitis. Preparatory to conducting a clinical evaluation study, to eliminate variation in patient effort during this maneuver, we evaluated the use of external acoustic energy-in place of humming-to elicit nNO transients, documenting the effects of varying stimulus amplitude and gas sampling rates. Methods: Non-smoking, non-asthmatic subjects with no history of chronic sinusitis or nasal polyposis underwent nNO measurements in triplicate under: (1) control (quiet) conditions, and (2) with 128 Hz external acoustic energy. In Experiment 1, twelve subjects were exposed to two different intensities of external acoustic energy at 3 L/min sampling rate. In Experiment 2, a subset of nine subjects was sampled with and without acoustic stimulation at three different gas sampling rates (1, 2, and 3 L/min). Results: Experiment 1: Subjects, as a group, showed intensity-related increases in nNO with increasing acoustic amplitude (p < 0.01). Experiment 2: independently, both applied acoustic energy and lower nasal gas sampling rates increased measured nNO levels (p < 0.05 to p < 0.0001). Longitudinally, baseline (quiet) nNO obtained on a repeated basis in the two experiments (n = 9) was highly reproducible (R 2 = 0.84; p < 0.001), and acoustically-stimulated nNO was moderately so (R 2 = 0.50; p < 0.05). Conclusions: Application of external acoustic energy is a practical alternative to humming for mobilizing NO from the paranasal sinuses, and could be more objectively applied in any future validation studies involving clinical sinusitis and/or OMC obstruction.

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Humming‐induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study

Abstract: Absence of a nasal NO peak during humming is associated with endoscopic findings suggestive of sinus ostial obstruction in subjects with allergic rhinitis. Measurement of nasal NO during humming may be a simple method to detect sinus abnormalities in these patients.

Cited by 45 publications

References 36 publications

Nitric oxide in upper airways inflammatory diseases

Nitric oxide in upper airways inflammatory diseases

Nasal Breathing Exercise and its Effect on Symptoms of Allergic Rhinitis

The Nasal Nitric Oxide Response to External Acoustic Energy: A Pilot Study of Sampling Dynamics

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