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Facial Plast Surg 2024; 40(03): 275-286
DOI: 10.1055/s-0043-1777850
Original Article

Nasal Obstruction: Overview of Pathophysiology and Presentation of a Clinically Relevant Preoperative Plan for Rhino(Septo)plasty

Simon Snoeks
1   Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium
,
Enrique Velasco
2   Department of Cellular and Molecular Medicine, Catholic University of Leuven Faculty of Medicine, Leuven, Belgium
,
Karel Talavera
2   Department of Cellular and Molecular Medicine, Catholic University of Leuven Faculty of Medicine, Leuven, Belgium
,
Peter W. Hellings
1   Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium
3   Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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Abstract

Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery.

Keywords

nasal obstruction - preoperative evaluation - rhinoplasty


Publication History

Article published online:
15 January 2024

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  • References

  • 1 Valero A, Navarro AM, Del Cuvillo A. et al; SEAIC Rhinoconjunctivitis Committee & SEORL Rhinology, Allergy, and Skull Base Committee. Position paper on nasal obstruction: evaluation and treatment. J Investig Allergol Clin Immunol 2018; 28 (02) 67-90
    CrossrefPubMedGoogle Scholar
  • 2 Dąbrowska-Bień J, Skarżyński H, Górski SF, Skarżyński PH. Quality of life in patients with nasal obstruction after septoplasty: a single institution prospective observational study. Int Arch Otorhinolaryngol 2021; 25 (04) e575-e579
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Hellings PW, Scadding G, Alobid I. et al. Executive summary of European Task Force document on diagnostic tools in rhinology. Rhinology 2012; 50 (04) 339-352
    CrossrefPubMedGoogle Scholar
  • 4 Doulaptsi M, Steelant B, Prokopakis E. et al. Prevalence and impact of nasal hyperreactivity in chronic rhinosinusitis. Allergy 2020; 75 (07) 1768-1771
    CrossrefPubMedGoogle Scholar
  • 5 Feijen J, Seys SF, Steelant B. et al. Prevalence and triggers of self-reported nasal hyperreactivity in adults with asthma. World Allergy Organ J 2020; 13 (06) 100132
    CrossrefPubMedGoogle Scholar
  • 6 Hsu DW, Suh JD. Anatomy and physiology of nasal obstruction. Otolaryngol Clin North Am 2018; 51 (05) 853-865
    CrossrefPubMedGoogle Scholar
  • 7 Kanjanawasee D, Campbell RG, Rimmer J. et al. Empty nose syndrome pathophysiology: a systematic review. Otolaryngol Head Neck Surg 2022; 167 (03) 434-451
    CrossrefPubMedGoogle Scholar
  • 8 Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: a literature review. Int Forum Allergy Rhinol 2014; 4 (10) 834-838
    CrossrefPubMedGoogle Scholar
  • 9 Karashima Y, Damann N, Prenen J. et al. Bimodal action of menthol on the transient receptor potential channel TRPA1. J Neurosci 2007; 27 (37) 9874-9884
    CrossrefPubMedGoogle Scholar
  • 10 Karashima Y, Talavera K, Everaerts W. et al. TRPA1 acts as a cold sensor in vitro and in vivo. Proc Natl Acad Sci U S A 2009; 106 (04) 1273-1278
    CrossrefPubMedGoogle Scholar
  • 11 Caterina MJ, Schumacher MA, Tominaga M, Rosen TA, Levine JD, Julius D. The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 1997; 389 (6653) 816-824
    CrossrefPubMedGoogle Scholar
  • 12 Talavera K, Startek JB, Alvarez-Collazo J. et al. Mammalian transient receptor potential TRPA1 channels: from structure to disease. Physiol Rev 2020; 100 (02) 725-803
    CrossrefPubMedGoogle Scholar
  • 13 Alonso-Carbajo L, Alpizar YA, Startek JB, López-López JR, Pérez-García MT, Talavera K. Activation of the cation channel TRPM3 in perivascular nerves induces vasodilation of resistance arteries. J Mol Cell Cardiol 2019; 129: 219-230
    CrossrefPubMedGoogle Scholar
  • 14 Velasco E, Delicado-Miralles M, Hellings PW, Gallar J, Van Gerven L, Talavera K. Epithelial and sensory mechanisms of nasal hyperreactivity. Allergy 2022; 77 (05) 1450-1463
    CrossrefPubMedGoogle Scholar
  • 15 Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet 2011; 378 (9809) 2112-2122
    CrossrefPubMedGoogle Scholar
  • 16 Bousquet J, Anto JM, Bachert C. et al. Allergic rhinitis. Nat Rev Dis Primers 2020; 6 (01) 95
    CrossrefPubMedGoogle Scholar
  • 17 Seidman MD, Gurgel RK, Lin SY. et al; Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152 (01) S1-S43
    PubMedGoogle Scholar
  • 18 Hellings PW, Scadding G, Bachert C. et al. EUFOREA treatment algorithm for allergic rhinitis. Rhinology 2020; 58 (06) 618-622
    CrossrefPubMedGoogle Scholar
  • 19 Fokkens WJ, Lund VJ, Hopkins C. et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 2020; 58 (Suppl S29): 1-464
    CrossrefPubMedGoogle Scholar
  • 20 Bachert C, Marple B, Schlosser RJ. et al. Adult chronic rhinosinusitis. Nat Rev Dis Primers 2020; 6 (01) 86
    CrossrefPubMedGoogle Scholar
  • 21 Hellings PW, Fokkens WJ, Orlandi R. et al. The EUFOREA pocket guide for chronic rhinosinusitis. Rhinology 2023; 61 (01) 85-89
    PubMedGoogle Scholar
  • 22 Hellings PW, Klimek L, Cingi C. et al. Non-allergic rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy 2017; 72 (11) 1657-1665
    CrossrefPubMedGoogle Scholar
  • 23 Liva GA, Karatzanis AD, Prokopakis EP. Review of rhinitis: classification, types, pathophysiology. J Clin Med 2021; 10 (14) 3183
    CrossrefPubMedGoogle Scholar
  • 24 Eifan AO, Durham SR. Pathogenesis of rhinitis. Clin Exp Allergy 2016; 46 (09) 1139-1151
    CrossrefPubMedGoogle Scholar
  • 25 Fokkens W, Hellings P, Segboer C. Capsaicin for rhinitis. Curr Allergy Asthma Rep 2016; 16 (08) 60
    CrossrefPubMedGoogle Scholar
  • 26 Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin North Am 2009; 42 (02) 207-225 , vii
    CrossrefPubMedGoogle Scholar
  • 27 Fermin JM, Bui R, McCoul E. et al. Surgical repair of nasal septal perforations: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12 (09) 1104-1119
    CrossrefPubMedGoogle Scholar
  • 28 Arnold MA, Yanik SC, Suryadevara AC. Septal fractures predict poor outcomes after closed nasal reduction: retrospective review and survey. Laryngoscope 2019; 129 (08) 1784-1790
    CrossrefPubMedGoogle Scholar
  • 29 Sanyaolu LN, Farmer SE, Cuddihy PJ. Nasal septal haematoma. BMJ 2014; 349: g6075
    CrossrefPubMedGoogle Scholar
  • 30 Bin Lajdam G, Alaryani K, Ghaddaf AA. et al. Septoplasty versus septoplasty with turbinate reduction for nasal obstruction due to deviated nasal septum: a systematic review and meta-analysis. Rhinology 2022; 60 (06) 411-420
    PubMedGoogle Scholar
  • 31 Alshaikh N, Lo S. Nasal septal abscess in children: from diagnosis to management and prevention. Int J Pediatr Otorhinolaryngol 2011; 75 (06) 737-744
    CrossrefPubMedGoogle Scholar
  • 32 Sayin I, Yazici ZM, Abakay MA, Saygan GB, Gunes S. Nasal septal hematoma and abscess in children: an uncommon otorhinolaryngology emergency revisited. J Craniofac Surg 2021; 32 (02) e125-e128
    CrossrefPubMedGoogle Scholar
  • 33 Chen YP, Chan ATC, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet 2019; 394 (10192): 64-80
    CrossrefPubMedGoogle Scholar
  • 34 Pirsig W. Nasaler Atembeschlagtest bei Zwaardemaker und Glatzel vor über 100 Jahren und in Paestum vor 2 300 Jahren [Test using vapourated expired nasal breathing in medicine 100 years ago and in paestum 2 300 years ago]. Laryngorhinootologie 2014; 93 (11) 739-745
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Brescovici S, Roithmann R. Modified Glatzel mirror test reproducibility in the evaluation of nasal patency. Rev Bras Otorrinolaringol (Engl Ed) 2008; 74 (02) 215-222
    PubMedGoogle Scholar
  • 36 Rimmer J, Hellings P, Lund VJ. et al. European position paper on diagnostic tools in rhinology. Rhinology 2019; 57 (Suppl S28): 1-41
    CrossrefPubMedGoogle Scholar
  • 37 Ottaviano G, Pendolino AL, Scarpa B. et al. Correlations between peak nasal inspiratory flow, acoustic rhinometry, 4-phase rhinomanometry and reported nasal symptoms. J Pers Med 2022; 12 (09) 1513
    CrossrefPubMedGoogle Scholar
  • 38 Stull DE, Krouse J, Meltzer EO. et al. Development and validation of the Congestion Quantifier seven-item test (CQ7): a screening tool for nasal congestion. Value Health 2007; 10 (06) 457-465
    CrossrefPubMedGoogle Scholar
  • 39 Esmaili A, Acharya A. Clinical assessment, diagnosis and management of nasal obstruction. Aust Fam Physician 2017; 46 (07) 499-503
    PubMedGoogle Scholar
  • 40 Villwock JA, Kuppersmith RB. Diagnostic algorithm for evaluating nasal airway obstruction. Otolaryngol Clin North Am 2018; 51 (05) 867-872
    CrossrefPubMedGoogle Scholar
  • 41 Spiekermann C, Savvas E, Rudack C, Stenner M. Adaption and validation of the nasal obstruction symptom evaluation scale in German language (D-NOSE). Health Qual Life Outcomes 2018; 16 (01) 172
    CrossrefPubMedGoogle Scholar