Damm M, Jungehülsing M, Schneider D, Eckel H E
Klinik und Poliklinik der Hals-Nasen-Ohrenheilkunde, Universität zu Köln.
Laryngorhinootologie. 1995 Oct;74(10):615-21. doi: 10.1055/s-2007-997813.
The distinction of the resistance in the nasal vestibule (valve area) and cavity (turbinates, septum deviations, crest, spine) is important for the settlement of the operative course in nasally impaired patients. Collapsed valves, free floating polyps, spines, and other turbulence producing factors in the nose are characterized in active anterior rhinomanometry (AAR) as decreased ¿percentage of flow increase¿ (deltaV150-300). This parameter allows no distinction between underlying anatomical factors. Other patients have increased resistance in the vestibule area that is static; rhinomanometry is unable to document these instances. The aim of this study was to investigate the influence of the vestibule dilator on nasal flow, and to determine if the diagnostic findings of AAR could be improved by the data obtained from the measurement with the dilator.
To prove the influence of the vestibule dilator on the nasal airflow, we determined typical rhinomanometric parameters in 20 nasally healthy and 40 nasally impaired persons with and without the dilator. For the measurements, we used a computer-aided rhinomanometer (Rhinodat K, Heinemann Medizintechnik, D-Hamburg). Tubular vestibule dilators were produced from silicon guide rails of tracheal tubes (Rüschelit, Fa. Rüsch, D-Kernen) and individually adapted to the patient's vestibule, ensuring dilation between the external ostium and the nasal isthmus.
Active interior rhinomanometry revealed a significant effect of the vestibule dilator in repeated application (mean variation 3%). Total nasal flow showed a mean increase of about 48% with the dilator. In AAR, we found 5 patients with decreased deltaV150-300 below 25%. To demonstrate the presence of vestibule stenosis, we compared the changes of deltaV150-300 is AAR with and without dilator. In rhinomanometry with the dilator, deltaV150-300 of patients with vestibule stenosis showed physiological values. In these patients, mean difference of deltaV150-300 between conventional rhinomanometry and rhinomanometry with a vestibule dilator was significantly higher (47,2%) than observed in all other persons (3,8%). The static vestibule resistance in the total nasal resistance was obtained by calculating the difference between nasal flows with and without the dilator. CONCLUSIONS; Stenosis in the nasal vestibule could be proved and measured via active anterior rhinomanometry using a vestibule dilator. Data obtained from this method are helpful in functional assessment of nasally impaired patients, particularly to answer the question of whether the vestibule requires surgical treatment.
区分鼻前庭（瓣膜区）和鼻腔（鼻甲、鼻中隔偏曲、嵴、棘）的阻力，对于确定鼻腔功能受损患者的手术方案很重要。鼻内塌陷瓣膜、游离漂浮息肉、棘以及其他产生湍流的因素，在主动前鼻测压法（AAR）中表现为“流量增加百分比”（deltaV150 - 300）降低。该参数无法区分潜在的解剖学因素。其他患者鼻前庭区域存在静态的阻力增加情况；鼻测压法无法记录这些情况。本研究的目的是调查前庭扩张器对鼻气流的影响，并确定通过扩张器测量获得的数据是否能改善AAR的诊断结果。
为证明前庭扩张器对鼻气流的影响，我们在20名鼻腔健康者和40名鼻腔功能受损者中，分别在使用和不使用扩张器的情况下测定典型的鼻测压参数。测量时，我们使用了计算机辅助鼻测压仪（Rhinodat K，Heinemann Medizintechnik，德国汉堡）。管状前庭扩张器由气管导管的硅胶导轨（Rüschelit，Rüsch公司，德国克嫩）制成，并根据患者的前庭进行个体化适配，确保在外鼻孔和鼻峡部之间实现扩张。
主动前鼻测压显示，重复使用前庭扩张器有显著效果（平均变化3%）。使用扩张器时，总鼻流量平均增加约48%。在AAR中，我们发现5名患者的deltaV150 - 300降低至25%以下。为证明前庭狭窄的存在，我们比较了使用和不使用扩张器时AAR中deltaV150 - 300的变化。在使用扩张器进行鼻测压时，前庭狭窄患者的deltaV150 - 300显示出生理值。在这些患者中，传统鼻测压与使用前庭扩张器的鼻测压之间deltaV150 - 300的平均差异（47.2%）显著高于所有其他人员（3.8%）。通过计算使用和不使用扩张器时鼻流量的差异，得出总鼻阻力中的静态前庭阻力。结论：使用前庭扩张器通过主动前鼻测压法可以证明和测量鼻前庭狭窄。该方法获得的数据有助于对鼻腔功能受损患者进行功能评估，特别是有助于回答前庭是否需要手术治疗的问题。
