title: Four-phase rhinomanometry: a multicentric retrospective analysis of 36,563 clinical measurements.
abstract: Rhinomanometry can still be considered as the standard technique for the objective assessment of the ventilatory function of the nose. Reliable technical requirements are given by fast digital sensors and modern information technology. However, the xyimaging of the pressure-flow relation typically shows loops as a sign of hysteresis, with the need for resolution of the breath in four phases. The three pillars of 4-phase rhinomanometry (4PR) are the replacement of estimations by measurements, the introduction of parameters related to the subjective sensing of obstruction, and the graphical information regarding the disturbed function of the nasal valve. In a meta-analysis of 36,563 clinical measurements, we analyze the errors of the "classic" parameters (flow in 150 Pa) and reject the further use of these parameters as obsolete, because they correspond to an inaccurate estimation rather than proper measurement. In a pre-study of 1580 measurements, the logarithmic effective resistance (Reff) was found to have the highest correlation with values obtained from a visual analog scale. Next, we classify the inspiratory effective resistance in 20,069 measurements without treatment and 16,494 measurements after decongestion with xylometazoline 0.1 % spray in 20 % percentiles. The gradation of obstruction delivers not only "normal" values but also indications for the severity of the obstruction in adult Caucasian noses. Adoption of the distribution for the growing nose and analysis of the total nasal resistance is addressed, and typical findings of nasal valve phenomena are outlined.
authors.affiliation: , Schwarzer Weg 3 B, 18292, Krakow Am See, Germany. rhinovogt@t-online.de.|Faculty of Medicine, Centre of Experimental Surgery, University of Latvia, Riga, Latvia. rhinovogt@t-online.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Vogt
authors.affiliation: Sostana GmbH, Wildensteiner Strasse 27, 10318, Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: PARK-KLINIK Weissensee GmbH, Schönstrasse 80, 13086, Berlin, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Behrbohm
authors.affiliation: Marienhospital Stuttgart, Böheimstrasse 37, 70199, Stuttgart, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gubisch
authors.affiliation: Faculty of Medicine, Centre of Experimental Surgery, University of Latvia, Riga, Latvia.
authors.forename: Mara
authors.initials: M
authors.lastname: Argale
mesh_terms: D000328:Adult; D000403:Airway Resistance / Q000502:physiology*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D014663:Nasal Decongestants / Q000627:therapeutic use; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D009666:Nose / Q000503:physiopathology; D010147:Pain Measurement; D012044:Regression Analysis; D012189:Retrospective Studies; D025363:Rhinomanometry / Q000379:methods*; D064232:Visual Analog Scale; D044465:White People
chemical_list: D007093:Imidazoles; D014663:Nasal Decongestants; C009695:xylometazoline
keywords: Clinical validation; Effective resistance; Four-phase rhinomanometry; Logarithmic transformation; Meta-analysis; Parameter