Humming-induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study.
BACKGROUND
Humming greatly increases nasal nitric oxide (NO) in healthy people by causing a rapid washout of NO from the sinuses. This increase is abolished in patients with complete sinus ostial obstruction.


OBJECTIVE
Allergic rhinitis is a risk factor for development of sinusitis and we wanted to study whether nasal NO measurement during humming could be used to detect sinus abnormalities in this disorder.


METHODS
Fifty-nine consecutive subjects with mild to moderate allergic rhinitis were studied. Their present nasal symptoms were recorded. Then NO levels were measured by chemiluminescence during quiet single-breath nasal exhalations and humming exhalations at a fixed exhalation flow of 0.2 L s(-1). Based on the NO results the patients were divided into two groups: those with a great increase in nasal NO during humming (humming responders, n = 46) and those without a significant increase (humming nonresponders, n = 13). In 11 of the nonresponders and in 22 of the responders the passage to the osteomeatal complex area was assessed and scored by nasal endoscopy. This was carried out by an oto-rhino-laryngologist unaware of the NO results.


RESULTS
Among the nonresponders nine of 11 patients (80%) had endoscopic signs of bilateral sinus obstruction, compared with one of the 22 (< 5%) humming responders. Baseline nasal symptom score and NO levels during quiet exhalation were not significantly different between the groups


CONCLUSIONS
Absence of a nasal NO peak during humming is associated with endoscopic findings suggestive of sinus ostial obstruction in subjects with allergic rhinitis. Measurement of nasal NO during humming may be a simple method to detect sinus abnormalities in these patients.
Karolinska Institutet, Stockholm, Sweden. mauromaniscalco@hotmail.com
M
M
Maniscalco
M
M
Sofia
E
E
Weitzberg
G
G
De Laurentiis
A
A
Stanziola
V
V
Rossillo
J O
JO
Lundberg
D000161:Acoustic Stimulation; D000293:Adolescent; D000328:Adult; D045853:Exhalation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D009569:Nitric Oxide / Q000378:metabolism*; D009666:Nose; D010256:Paranasal Sinuses / Q000378:metabolism*; D010865:Pilot Projects; D012221:Rhinitis, Allergic, Perennial / Q000150:complications*; D012852:Sinusitis / Q000175:diagnosis* / Q000209:etiology
D009569:Nitric Oxide