Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

Chin, D.; Marcells, G.; Malek, J.; Pratt, E.; Sacks, R.; Snidvongs, Kornkiat; Harvey, Richard J.

doi:10.4193/rhin13.126

Cited by 16 publications

(18 citation statements)

References 12 publications

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“…The nasal decongestant eliminates the nasal cycle, 34 and is routinely used in assessment of the nose. 32 Our hypothesis is that specific nasal diseases display unique responses to decongestant and expands further on the decongestable and non-decongestable nasal obstruction hypothesis outlined by Chin et al 15…”

Section: Methods Of Studymentioning

confidence: 65%

“…14 However, NIPF cannot diagnose the cause of nasal blockage however changes in NIPF following decongestant can help in distinguishing the presence of decongestable nasal obstruction. 15 There is also an increasing drive from NHS England to streamline diagnostics in primary care and reduce secondary care referrals for ENT conditions which could be easily diagnosed and managed within primary care if the technology is available. 16 This would reduce the demand on costly secondary care services and improve cost efficiency.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study

Kaura

Tan

et al. 2020

Laryngoscope Investig Oto

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Objectives: There is a need to develop a medical device which can accurately measure normal and abnormal nasal breathing which the patient can better understand in addition to being able to diagnose the cause for their nasal obstruction. The aim is to evaluate the accuracy of the nasal acoustic device (NAD) in diagnosing the common causes for nasal obstruction and diagnosing normal and abnormal (nasal obstruction) nasal breathing. Methods: This pilot study recruited 27 patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS), and a deviated nasal septum (DNS) which represents the common causes for NO and 26 controls (with normal nasal breathing). Nasal breathing sounds were recorded by the NAD akin to two small stethoscopes placed over the left and right nasal ala. The novel outcome metrics for the NAD include inspiratory nasal acoustic score (INA) score, expiratory nasal acoustic (ENA) score and the inspiratory nasal obstruction balance index (NOBI). The change in acoustic score following decongestant is key in this diagnostic process. Results: Pre-decongestant ENA score was used to detect the presence of nasal obstruction in patients compared to controls, with a sensitivity of 0.81 (95% CI: 0.66-0.96) and a specificity of 0.77 (0.54-1.00). Post-decongestant percentage change in INA score was used to identify the presence of AR or CRS, with a sensitivity of 0.87 (0.69-1.00) and specificity of 0.72 (0.55-0.89) for AR; and a sensitivity of 0.92 (0.75-1.00) and specificity of 0.69 (0.52-0.86) for CRS. Post-decongestant inspiratory NOBI was used to identify DNS, with a sensitivity of 0.77 (0.59-0.95) and specificity of 0.94 (0.82-1.00).

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Section: Methods Of Studymentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study

Kaura

Tan

et al. 2020

Laryngoscope Investig Oto

View full text Add to dashboard Cite

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“…Whilst post-decongestant change in the measured values have been described as a way to distinguish between rhinitic and structural obstructions in the nose [29], we have shown that the post-decongestant effect could also be used to distinguish between different types of rhinitic conditions such as allergic rhinitis and CRS. The results in this study demonstrate a difference between the CRS group and the non-CRS groups, with the latter generally having higher postdecongestant percentage changes in both the NIPF and INA score (post-decongestant increase for the former, decrease for the latter).…”

Section: Discussionmentioning

confidence: 83%

Assessing nasal obstruction with the nasal acoustic device: a pilot study on distinguishing between subjects with and without chronic rhinosinusitis

Tan

Whitcroft

et al. 2019

Preprint

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This article aims to demonstrate the concept and potential of a novel diagnostic device -the nasal acoustic device (NAD), which captures the nasal breathing sounds over the ala on both sides of the nose. Using the newly defined inspiratory nasal acoustic score (INA score), the unique characteristics of the nasal breathing sounds can be quantified and used for diagnostic purposes.In this pilot study, the NAD was compared with the well-established nasal inspiratory peak flow meter (NIPF) to try to distinguish between subjects with and without chronic rhinosinusitis (CRS).Measurements were made before and after nasal decongestants, which were applied to eliminate the nasal cycle. Patients were divided into two groups based on the presence or absence of CRS, irrespective of other pathological conditions being present.Based on the post-decongestant measurements, the sensitivity/specificity in distinguishing subjects who have CRS (n=11) from subjects who do not (n=29; of whom 13 were controls) were 70%/66% for the NIPF and 82%/79% for the NAD. The non-CRS groups showed statistically significant changes after decongestant for both methods, but the CRS group did not. The results firstly demonstrated that the CRS subjects in this cohort tended to be less responsive to decongestant and therefore the post-decongestant NIPF measurements provided a certain degree of diagnostic value in identifying CRS subjects, but it would appear the NAD better captured the unique sounds associated with CRS, providing a superior diagnostic capability. This study also demonstrates that the NAD can measure the improvement in the nasal airway following treatment effect.

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“…This mucosal change of the inferior turbinate is irreversible and subsequently becomes non‐decongestable. Chin et al . defined these non‐decongestable patients as patients whose nasal peak inspiratory flow increases of less than 20 L/min after decongestion.…”

Section: Discussionmentioning

confidence: 99%

“…They found that the eosinophil influx after nasal challenge with dust mites was reduced in the turbinoplasty group. Predecongestion and postdecongestion peak nasal inspiratory flows were suggested by Chin et al . for selecting patients suitable for inferior turbinate reduction.…”

Section: Discussionmentioning

confidence: 99%

Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta‐analysis

Khattiyawittayakun

Seresirikachorn

Chitsuthipakorn

et al. 2018

Int Forum Allergy Rhinol

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Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction

Abstract: NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

Cited by 16 publications

References 12 publications

Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study

Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study

Assessing nasal obstruction with the nasal acoustic device: a pilot study on distinguishing between subjects with and without chronic rhinosinusitis

Effects of decongestant addition to intranasal corticosteroid for chronic rhinitis: a systematic review and meta‐analysis

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