Gosepath Jan, Amedee Ronald G, Mann Wolf J
Department of Otolaryngology, Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany.
Laryngoscope. 2005 Mar;115(3):512-6. doi: 10.1097/01.MLG.0000149682.56426.6B.
Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard.
标准化鼻激发试验（NPT）已被证明是诊断变应性和非变应性鼻炎的一种安全且非常有用的工具。然而，在美国，其应用大多局限于科学研究，尚未被广泛接受为临床实践中的标准诊断程序。NPT旨在识别并量化吸入性变应原或职业性刺激物的临床相关性。在NPT期间，鼻呼吸黏膜暴露于怀疑会使个体出现症状的空气传播物质中。临床反应以可控且标准化的方式进行监测。评估鼻分泌物、瘙痒、打喷嚏等症状，最重要的是评估鼻塞，以及眼部、支气管、皮肤和全身反应。为了获得激发后鼻气流和通畅度变化的客观数据，前鼻测压法和声反射鼻测量法已被纳入NPT的标准方案中。通过一方面监测鼻气流变化，另一方面监测鼻腔形态变化，这些方法以图形方式展示鼻功能，就如同言语和纯音听力测定法展示听觉功能一样。此外，由于其客观性，这些方法提供了一个清晰且国际可比的标准。本综述概述了NPT方案，并讨论了实际应用和临床适应证。强调了将鼻测压法和声反射鼻测量法用作客观诊断工具。对于变应性和职业性鼻炎的诊断，标准化NPT应被视为国际诊断标准。
