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Objectives:
Due to development of new devices, the study of the nasal aerodynamics
has acquired an ever-increasing value, especially during recent years.
This is accounted for by the fact that with the advent of a special
device (Y.P.Ulyanov, P.P.Polivanov, 1988), it has become possible to
examine separate air flows in the nasal passages both at inspiration
and expiration, to establish the normogram of the nasal aerodynamics
and to determine its two extreme variants: "the northern" and the
"southern" (Y.P.Ulyanov, 1995, 1996, 1997). Patients with the "northern"
type are better adapted to the harsh air of the mid-latitude temperate
zone and probably therefore they catch a cold very seldom (once in 4-5
years). Persons with the "southern" type of aerodynamics are less
protected in this aspect. They catch a cold regularly in autumn and
winter more than once, forming the population of those disposed to
epidemics of influenza. As a result, resistance of patients to acute
rhinitis caused by common cold is in fact a qualitative criterion of
efficiency of the protective properties of nasal aerodynamics. This
correlation is especially clearly demonstrated after surgical
reconstruction of the "northern" type of aerodynamics out of the
"southern" one (Y.P.Ulyanov, 1997). The otherwise, after this surgical
reconstruction of nasal aerodynamics the dry and subatrophic mucosa of
nose becomes soft and moist without any signs of inflammation, and
resistant to common colds of the wet seasons.
METHODS
Therefore at present, having at our disposal the extreme variants
of the protective properties of nasal aerodynamics are as the
criteria of their efficiency, we can examine all transitional forms
and evaluate them from the clinical point of view.
During endonasal rhinomanometry, we studies of nasal aerodynamics
in 1000
patients with frequent fits of common cold and 300 practically healthy
people facilitated detection of clinical manifestations of 2 extreme
types of nasal aerodynamics, which had been observed previously by
scientists. These are the "northern" type of nasal aerodynamics (NTA)
and the "southern" type of nasal aerodynamics (STA).
Using the principle of moving the main airstream at inspiration from
MM
to IM, patients were divided into 7 nasal aerodynamics groups, with
airstream pressures differing from each other by 10 conditional units
(CU) = 25 Pascal (Pa).
MM at inspiration. Table 1.
In Table 1, distribution of airstream at inspiration between IM and MM
appears to be the main distinctive criterion of groups of patients with
various values for nasal aerodynamics. The age range of patients was 2-86
years with a 1:1 male-to-female ratio. Clinical manifestations of different
diseases in each of the nasal aerodynamic groups are marked with (+) to
indicate less than 5% incidence, with (++) to indicate 6-10% incidence,
and with (+++) to indicate incidence over 11%.
RESULTS:
Healthy patients adapted to average and northern latitudes made up 3 groups
with 150-200 Pa entering MM at inspiration. Patients with regular seasonal
colds were in 4 groups with airstream pressures of 50-125 Pa entering
Apart from the detection of 2 extreme types of nasal aerodynamics, as
the "northern" and "southern" type of nasal aerodynamics has been established
and group of patients with complete equilibrium of the distribution of air
flows between middle and inferior nasal passages (50 CU/50 CU). The patient
of this group as and other three groups with 50-125 Pa (40 CU, 30 CU and 20 CU)
had caught a cold frequently. At the same time, among the persons who were
practically healthy and possess the "northern" type of aerodynamics there
are two more groups with 150-200 Pa (60 CU and 70 CU)were well adapted to
average and northern latitudes. The entry of the air flow through the
superior nasal passage was approximately stable (10 CU in each group)
and was not related to the distribution of air flows along the other
nasal passages. As a result, 250 Pa (100 CU) were to go through the inferior
and medial nasal passages. E.g., in the "southern" type of aerodynamics
20 CU go through the medial nasal passage, with 80 CU entering the inferior
nasal passage. In patients with the "northern" type of aerodynamics, the
situation was reverse, i.e. 80 CU go through the medial nasal passage, with
20 CU entering the inferior nasal passage. Clinical manifestations of these
variants of distribution of the air flows were especially evident
(Second part of Table 1).
| |
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Table 1. Variants of distribution of airstream among nasal passages at
inspiration
|
Nasal passages |
1,000 persons with
seasonal catch a cold. |
300 practically
healthy persons. |
Olfactory area (Pascal) |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
Middle meatus (Pa.) |
50 |
75 |
100 |
125 |
150 |
175 |
200 |
Inferior meatus (Pa.) |
200 |
175 |
150 |
125 |
100 |
75 |
50 |
Clinical manifestations
|
Annual occurrence
rate of catch a colds |
1-2 |
2-4 |
2-3 |
1-2 |
Catch a cold
once for 4-5 years |
Otitis |
- |
+ |
+ + |
+ |
- |
- |
- |
Sinusitis |
+ |
+ + |
+ + + |
+ + |
- |
- |
- |
Vasomotor rhinitis. |
- |
+ + |
+ + + |
+ + + |
+ |
- |
- |
Subatrophic mucosa of SRW |
+ + + |
+ + + |
+ + |
+ |
+ |
- |
- |
Atrophic mucosa of SRW |
+ + |
- |
- |
- |
- |
- |
- |
Tracheobronchitis |
+ + + |
+ + |
+ |
- |
- |
- |
- |
Laryngospasms |
+ |
+ |
- |
- |
- |
- |
- |
Bronchial asthma |
+ + |
+ |
- |
- |
- |
- |
- |
Pneumonia |
+ + |
+ |
+ |
- |
- |
- |
- |
Ozena |
+ + |
- |
- |
- |
- |
- |
- |
The data of the Table demonstrate that appearance of rhinitis in
directly depended upon the shift of the main air flow from the
medial nasal passage to the inferior one. As long as the main air
flow at inspiration entered through the medial nasal passage,
patients caught a cold very seldom (once in 4-5 years), however,
a slightest disturbance of this situation, be it only in 10 CU, with
the distribution of air flows becoming an equal value (50/50),
patients suffer from colds every year (up to twice a year). The
further shift of the air flow to the inferior nasal passage increases
the trend to two to three colds annually (with an additional 10 CU)
and to four colds a year (with an additional 20 CU). However, further
shift of the air flow to the inferior nasal passage (to 80 CU) causes
a fifty-percent drop in the advent of seasonal cold of the superior
respiratory ways, which suggests a contradiction to the above-mentioned
trend and demands the further investigation. Therefore, we have
carried out an additional analysis of correlations between clinical
manifestations as related to the level of the shift of the air flow
to the inferior nasal passage one. The leading place among the
clinical manifestations is held by the subatrophic process of the
mucosa of the nose, larynx and pharynx to be seen even in the group
of healthy persons with 60 CU. Whereas a further shift of the air
flow to the inferior nasal passage was causes the next increased
subatrophic process with the maximum value to be reached in the
persons with the "southern" type of nasal aerodynamics, when the
atrophic process is already detected. The latter seems to be not so
much evident in the "southern" nasal aerodynamics, so that the mucosa
cannot probably respond with the protective inflammatory reaction in
the form of acute rhinopharyngitis caused by seasonal colds with the
occurrence rate being half as high. A false conclusion comes to mind
that the atrophic process as if protects us from common cold. But is
it so? It turns out that in this group of patients a deeper involvement
of the inspiratory ways in the form of tracheobronchitis which occur
less frequently as long as the air flow returns to the medial nasal
passage, with a nearly complete disappearance when the equilibrium
of the air flows is reached. Moreover, this group of patients suffer
from fits of laryngospasms, and bronchial asthma, with the
inflammatory process reaching even the lungs, often causing pneumonia.
Therefore, excessive dryness of the mucosa of the superior
inspiratory ways, while reducing the occurrence rate of acute seasonal
rhinopharyngitis, lets the harsh air pass into the inferior
inspiratory ways causing more severe diseases such as tracheobronchitis,
bronchial asthma, and pneumonia, which is a further confirmation of
the detected main trend. i.e. a correlation between the status of the
inspiratory ways and the level of redistribution of the air flow at
inspiration between the medial and inferior nasal passages, i.e. the
evident protective properties of the nasal aerodynamics. This
correlation is also corroborated by local clinical manifestations
near the nose. Acute rhinitis is detected in groups with the air flow
values at inspiration from 50 to 40 or 30 CU. Sinusitis is seen in
groups with 50-40, 30 and 20 CU, with the following association taking
place. The more pronounced mucosal atrophy is, the less frequently it
occurs, but at the same time there is a risk of ozena. The reduced
protective response of the mucosa with increased subatrophic process
and appearance of atrophy is confirmed also by manifestations of
vasomotor rhinitis which is so aggressive that affect even
practically healthy persons in the group till 60 CU, but it occurs
frequently also in the group with 30 CU, although it is not
practically found in the group with 20 CU. Having studied certain
correlations of the distribution of the air flow at inspiration, we
cannot but take into account also the distribution of the air flow at
expiration, as the latter affects the rate of compensatory influence
of the warm and humid air flow on the mucosa of the inferior nasal
passage damaged by the "harsh" air at inspiration.
CONCLUSION:
Clinical manifestations of reduction of the protective properties of nasal
aerodynamics, such as frequent colds with local complications (eg,
sinusitis, otitis, CR), occur in equal distribution of airstream between MM
and IM. Further moving of the main airstream into IM on inspiration is
accompanied by frequent colds and more serious complications with
compromise of respiratory passageways, leading all the way to ozena,
bronchial asthma, and pneumonia.
REFERENCES:
Uliyanov Y.P., Polivanov P.P. Russian patents นน 1,572,505; 1,602,472,(1988).
(In Russian).
Uliyanov Y.P. Nose aerodynamics. Arch. Otolaryngol. Head Neck Surg.
1995; 121: 352
Uliyanov Y.P. Nose aerodynamics. Jor. Vrach, Moscow, 1996; 11: 39-40.
(In Russian).
Uliyanov Y.P. Method reconstruction of nasal aerodynamics. Jor. Vrach,
Moscow,1997; 7: 31-33. (In Russian).
Ulyanov Y.P. Normogram of nasal aerodynamics. XYI World Congr. Of Otolar.
Head Neck Surg.(Sydney, Australia, 2-7 March, 1997: 1603-1607.
Uliyanov Y.P. Surgical reconstruction of nasal aerodynamics. XYI World
Congr. Of Otolar. Head Neck Surg.(Sydney, Australia, 2-7 March, 1997: 1591-1595.
Uliyanov Yu. Clinical Medicine (Reference book of a practicing physician).
MSPI, Moscow, 1997,V-2:1103 - 1152. (In Russian).
Uliyanov Y.P. Relaytions bitween bronchial-pulmonary conditions and
nasal aerodynamics. Vestnic of the Center of Endosurgery and Lithotripsy,
Moscow, 1997; 1: 32-37. (In Russian).
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