Diagnostik av övre luftvägshinder med hjälp av nasal luft-flödesanalys
Project number : 2837
Created by: Johan Hellgren, 2007-09-26
Last revised by: Johan Hellgren, 2017-02-28
Project created in: FoU i Västra Götalandsregionen

PublishedPublished

1. Översiktlig projektbeskrivning

Engelsk titel

Monitoring of upper respiratory resistance by nasal air-flow analysis.

Populärvetenskaplig sammanfattning av projektet

Syftet med studien är att undersöka om analys av flödes kurvan vid näsandning från en vanlig flödesmätare,kan användas som en enkel och säker klinisk metod för att diagnostisera och kvantifiera nästäppa. Flödesmätning av näsandning med en liten näsgrimma är idag en standardundersökning för att kartlägga förekomsten av andningsuppehåll vid utredning av snarkning men då beaktas bara av om ett näsandningsflöde förekommer eller ej. Flödeskurvans utséende varierar dock med andningsmotståndet och genom analys av denna kan man "indirekt" bestämma andningsmoståndet.
Eftersom det idag saknas objektiva mätinstrument för att mäta nästäppa i kliniken trots att detta är en mycket vanlig patientgrupp avser projektet att jämföra flödesanalys med rhinomanometri som är "guld standard" för mätning av flödesmotstånd i näsan och akustisk rhinometri som båda ej är praktiskt användbara i kliniken. Om flödesanalys visar god överensstämmelse med etablerade metoder kan denna metod genom sin enkelhet och snabbhet vara en potentiell metod för diagnos och uppföljning av behandling av nästäppa inom primvård och specialiserad ÖNH-sjukvård

Vetenskaplig sammanfattning av projektet

More than 20% of the population in Sweden and Europe suffer from allergic rhinitis and an estimated further 20 % from non-allergic rhinitis. The most common and bothersome symptom reported by patients with allergic rhinitis is nasal blockage. About 4% of the population in Sweden show mechanical obstruction in their nose due to deviation of the nasal septum requiring surgery to cure. Most patients with nasal blockage are being assessed in primary care based on patient history due to lack of a simple and reliable tool to assess nasal air flow restriction. Due to the complex interior geometry of the two parallel nasal cavities lined by nasal mucosa that continuously change, flow mechanics of the nose is difficult to predict. An ocular inspection gives the best information to date and this is the tool used by specialists but seldom carried out in the primary care where most patients are assessed. In specialist clinics the combination of patient history and a thorough inspection is the predominant assessment when deciding upon therapy including surgery.
3 methods to assess nasal obstruction objectively have been introduced over the years and thoroughly validated for the use to assess nasal obstruction, rhinomanometry, acoustic rhinometry and peak nasal inspiratory/expiratory flow. Today none of these methods are currently in regular use in primary care and only to a limited extent in specialist care due to cost and methodological problems.
Flow analyses of nasal air flow during tidal breathing could be the first objective method to be used on a larger scale in primary care to diagnose or exclude significant nasal air way obstruction. As such the method could be used for screening as well as to support the specialist in the decision on surgical or medical treatment and follow-up. The method could also be evaluated for the use in diagnostics of air flow restriction during sleep where the flow trace has previously been used as an all or none variable for the presence or absence of nasal breathing.
Patients referred from primary care physicians on the diagnosis of subjective nasal obstruction aged 18-75 are telephoned and asked to participate in the study. After informed consent they are consecutively included in the study. Patients unable to breathe through their nose are excluded.
The study subjects fill out a questionnaire regarding asthma and allergic rhinitis, smoking habits, medication, previous nasal surgery and current nasal symptoms. A skin prick test is carried out. The nose is inspected with a nose speculum and presence of nasal polyps, septal deviation, and turbinate hypertrophy is recorded. The subjects scored their present subjective sensation of nasal blockage on a 110 mm VAS scale where 0 meant no nasal blockage and 147 mm total nasal blockage.
Intranasal geometry is assessed with acoustic rhinometry according to the international consensus protocol. The subject is then asked to sit on a chair in a quite room adjacent to the waiting room and rest. A nasal cannula (Pro-Flow, Pro-Tech) is fitted at the nasal openings and secured behind the ears and tightened under the cheek in a firm but comfortable position. Magazines are offered to the subjects to read during the measurement to distract from focusing on their breathing. Subjects are asked to breathe normally through the nose and trying not do pay any attention to their breathing. They are specifically asked not to breathe through their mouth with the exception of 1-2 breaths every 10-15 seconds if they are unable to maintain nasal breathing continuously due to nasal obstruction.
The cannula is fitted to a Flow Wizard. After the measurement the Flow Wizard was
docked to a pc and the data was extracted.
The subject is then measured with rhinomanometry (Tegnér, Sweden) according to the
international consensus protocol.
Cotton soaked in Nafazoline-Lidocain decongestant solution is then inserted in each
nasal cavity and kept in place for 10 minutes.
A skin-prick test (ALK, Sweden) is applied on the volar side of the lower arm. A standard
panel including: timothy grass, birch, mugwort, cat, dog, horse, house dust mite, fungi
and a positive (histamine) and negative control was applied for 20 minutes. The wheal
reaction is recorded.
After removal of the cotton from nasal cavities the subjects are asked to score their
sensation of nasal blockage on the VAS scale. Finally the acoustic rhinometry, the
Flow Wizard and the rhinomanometry are repeated according to the protocol above.
We compare the flow parameters before and after decongestion. The clinical assessment is then compared to the FW measurement to see in what degree nasal air flow analyses can be used to predict mechanical nasal obstruction.

Typ av projekt

Forskningsprojekt

MeSH-termer för att beskriva typ av studier

checked Klinisk prövning (Clinical Trial)


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MeSH-termer för att beskriva ämnesområdet

information Added MeSH terms
Intervention Studies
Epidemiologic investigations designed to test a hypothesized cause-effect relation by modifying the supposed causal factor(s) in the study population.
Nasal Obstruction
Any hindrance to the passage of air into and out of the nose. The obstruction may be in the nasal vestibule, fossae, or other areas of the nasal cavity.
Nose Diseases
Disorders of the nose, general or unspecified.
Respiration Disorders
Diseases of the respiratory system in general or unspecified or for a specific respiratory disease not available.
Airway Obstruction
Any hindrance to the passage of air into and out of the lungs.
Adolescent
A person 13 to 18 years of age.
Adult
A person having attained full growth or maturity. Adults are of 19 through 44 years of age.
Middle Aged
Description missing
Men
Human adult males as cultural, psychological, sociological, political, and economic entities.
Women
Human adult females as cultural, psychological, sociological, political, and economic entities.

Projektets delaktighet i utbildning

checked Ej del i utbildning


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2. Projektorganisation och finansiering

Arbetsplatser involverade i projektet

information Added workplaces
Företag - Privata vårdgivande bolag - inom Västra Götalandsregionen - Specialiserad vård - Capio Lundby Närsjukhus workplace verified by Västra Götalandsregionen on 2018-02-27

3. Processen och projektets redovisning

Detaljerad projektbeskrivning

Utvärdering av data pågår. Data valideras.

Diagnostik av övre luftvägshinder med hjälp av nasal luft-flödesanalys, from FoU i Västra Götalandsregionen
http://www.researchweb.org/is/html/vgr/project/2837