This document discusses various methods for objectively measuring nasal patency and airflow, which is important for accurately assessing complaints of nasal obstruction. It describes rhinomanometry, which measures nasal resistance, and acoustic rhinomanometry, which provides anatomical data on nasal cross-sectional area. Several other tests are also mentioned, including peak nasal inspiratory flow, body plethysmography, and questionnaires. Overall, the document provides an overview of existing objective methods for evaluating nasal function and structure to help diagnose the cause of a blocked nose.

1. By- Dr. Supreet Singh Nayyar,
AFMC
www.nayyarENT.com 1

2.  Complaint of a blocked nose
 Complex clinical problem
 Frequently difficult to assess
 The perception of nasal airflow - subjective
 Efforts to improve our ability to ‘objectively’
measure nasal patency
 Gold standard would be a quantifiable,
reproducible, objective test with a strong
correlation to the subjective perception of
nasal airflow
 Various methods
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3.  Rhinomanometry provides a functional
measure of the nasal airway resistance or
conductance
 Acoustic rhinometry provides an anatomical
measurement of cross-sectional area or nasal
volume
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4.  Dynamic test of nasal function that
calculates nasal airway resistance (NAR)
 Measures
 Transnasal pressure
 Nasal airflow
 Flow-pressure curves
 Laminar airflow versus turbulent airflow
 Three methods
 Active anterior rhinomanometry
 Passive anterior rhinomanometry
 Active posterior rhinomanometry
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5. www.nayyarENT.com 5

6.  UNILATERAL NASAL AIRFLOW Measured at sample
pressure point of 150 Pa and bilateral nasal airflow
measured at 75 Pa are recommended as universal
standards
 However, Asian population cannot always achieve
these pressures during normal quiet breathing and
the lower sample pressures of 100 and 50 Pa,
respectively, are generally accepted for nasal
resistance measurements in Japan.
 Total nasal resistance to airflow can be either
determined directly using the posterior method of
rhino manometry or it can be calculated by
combining the two separate values of nasal
resistance for the two nasal passages as shown in the
formula below:
 1/R (total) = 1/r (left) + 1/r (right)
 The reciprocal of total resistance is equal to the sum
of the reciprocals of left and right resistance.
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7.  Based on the analysis of sound waves
reflected from the nasal cavity
 Two -dimensional picture of the nasal cavity
 Can identify the narrowest part of the nasal
cavity or minimal cross-sectional area (MCA)
 Usually corresponds to the nasal valve area
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8. www.nayyarENT.com 8

9.  Peak nasal inspiratory flow rate
 Body plethysmograhy
 Nasalance
 Measured by pair of directional microphones mounted on
either side of hard palate
 Ratio of nasality of sound output from nose vs mouth
 Inversely proportional to nasal airway resistance
 Normal 40%
 Rhinostereometry
 Plotting of changes of inf turbinate by binocular
microscope
 Patient head fixed by biting into tailor made tooth splint
fixed on microscope
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10. Nasal Obstruction Symptom Evaluation Scale
 Symptoms over past one month
Not a Very mild Mod Fairly bad Severe
problem problem problem problem problem
Nasal
}
Congestion
Nasal
Blockage
Breathing 0 1 2 3 4
Difficulty
Trouble sleeping
Unable to get air
during exercise
*Nose Scale 2003 The American Academy of Otolaryngology and Head & Neck
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11.  Another subjective
 SNOT 22 (Sino Nasal Outcome Test)
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12.  Vasoconstrictors
 Drugs
 Surgery
 Nasal Cycle
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13.  Nasal challenge test
 This test provides precise measurements of
changes in nasal airway resistance along with
observations such as number of sneezes and
measurement of inflammatory mediators in
the nasal secretions after exposure to an
allergen. The more commonly known "sniff
test," uses a visual assessment of mucosal
swelling and rhinorrhea after a small amount
of dry pollen is inhaled.
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14. www.nayyarENT.com 14