Changes in the amplitude of the nasal cycle associated with symptoms of acute upper respiratory tract infection.

Nasal airflow is normally asymmetrical and subject to spontaneous reciprocal changes which are often referred to as the 'nasal cycle'. The nature of these spontaneous changes in nasal resistance is poorly understood and little information is available about how they are affected by nasal disease. In order to understand the changes in nasal resistance in health and disease it is important to record unilateral resistance rather than express results as total nasal resistance. Unilateral resistance is subject to continuous reciprocal changes and therefore new measurements were developed in this study in order to quantify the nasal resistance of each nasal passage. Twelve human subjects (age 19-38) with symptoms of acute respiratory tract infection (URTI) were recruited for the study which involved serial measurements of unilateral nasal airway resistance using the technique of posterior rhinomanometry over a period of six hours. Measurements were made on one day when subjects had symptoms of URTI and then repeated 6-8 weeks later when subjects were healthy. The results of this study show that all of the subjects exhibited spontaneous reciprocal changes in nasal airway resistance on both study days but that there was a significant increase in the amplitude of the changes in resistance when the subjects had symptoms of URTI with one nasal passage often becoming severely congested. In order to quantify the amplitude of the reciprocal changes in nasal resistance two new measures were used. The minimum and maximum nasal airway resistance recorded for each nasal passage during the six hour recording period (MIN NAR and MAX NAR). Mean MIN NAR with URTI was 0.4 Pa cm3s +/- 0.07 which was not significantly different from mean MIN NAR in health which was 0.36 Pa cm3s +/- 0.05 (p = 0.22, n = 20). The mean MAX NAR during URTI was 2.44 Pa cm3s +/- 0.38 and this decreased significantly to 1.36 +/- 0.17 when recorded during healthy conditions (p = 0.01, n = 20). The increased amplitude of spontaneous reciprocal changes in nasal airway resistance associated with symptoms of URTI is proposed to be due to an increased filling pressure to the nasal venous sinusoids associated with a nasal inflammatory response. A model is proposed to explain the role of the nasal sympathetic vasoconstrictor tone and nasal venous filling pressure in the control of nasal airway resistance and to help explain the periods of unilateral nasal obstruction often associated with allergic and infective rhinitis.