Contemporary Diagnostic of Nasal Obstruction - Basic Errors and How to Avoid Them - Abstract
Missing success in rhinosurgery or conservative treatment of nasal obstruction can be caused by insufficient or erroneous diagnostic. The review follows recent critical analyses of test methods for nasal obstruction by scientists and rhinologists and describes new ways as to the state of art in science and technique. 4-Phase-Rhinomanometry (4PR) with logarithmic parameters is the basic method to determine the degree of obstruction and to classify it. The detailed morphologic analysis can be carried out by Computational Fluid Dynamics (CFD) or transferring radiological DICOM-data into stereolithography- files and generating 3D-printed models. A preoperative simulation of surgical steps can be carried out by both methods.
Following Weber-Fechner´s basic law of psychophysics a correlation between the feeling of obstruction and rhinomanometric results can be achieved only by applicating logarithmic parameters.
The nose is a Starling-resistor and the quantitative determination of the nasal valve activity is mandatory. It is possible by the evaluation of loops in 4PR-diagrams. More precise methods are under development.
The morphology and function of the nasal airway has to be included in the diagnosis of sleep disordered breathing. The influence of the body position can be determined and the effectivity of nCPAP-treatment or surgery predicted.
Simplified methods as PNIF should be refused because of missing consideration of the nasal valve elasticity.
Subjective scores (NOSE-score, SNOT-score) have a limited meaningfulness in rhinological diseases, where obstruction determines the severity. The feeling of obstruction is better described by Visual-analogue-scales (VAS) recorded together with 4PR-measurements.