Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be ap- plied externally or endonasally. It remains unknown to what extent the endonasal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery.
Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery.
The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 %. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator.
The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.
Patients suffering from nasal obstruction due to nasal valve compromise may benefit from a nasal dilator. Several devices for widening of the external/internal nasal valve region can be applied endonasal (Airmax®, Nasanita®, Nozovent®) or externally (Breathe Right®).
100 patients suffering from nasal obstruction due to external or internal nasal valve compromise were involved in this study. All patients were evaluated for nasal obstruction with visual analogue scores (VAS) and peak nasal inspiratory flow (PNIF) measurements before and after the application of 4 nasal dilators. They were offered to choose 2 out of 4 for a trial period of 1 month. Subsequently, patients were reassessed and asked about their willingness to continue using the dilators, as well as the reasons for discontinuation.
There was a significant decrease of VAS scores and improvement in PNIF with the dilators in situ compared to baseline. After 4 weeks, 67% of the patients were willing to continue using at least one of the chosen dilators. The reasons for discontinuation were local irritation, inappropriate fit, preference for a permanent solution like surgery, and no relief of symptoms.
Nasal dilators represent a valuable option in the therapeutic approach of nasal valve compromise, with endonasal dilators achieving higher increase in PNIF in comparison with external nasal dilators.
Nasal dilators are a non-invasive device, which may improve nasal breathing remarkably. They are used by sportsmen, but also by patients with impaired nasal breathing for different reasons. Snoring and even symptoms of mild sleep apnoea may be reduced, but the effect is not predictable. Publications reporting about the results of application are coming to different conclusions. It can be shown by measuring the effect of the dilator by means of 4-phase-Rhinomanometry.
Prospective study performed from November 2009 to April 2010. During the study the users subjective opinions about comfort, effectiveness and side effects of nasal dilators were compared and analysed. Subsequently the effects of two nasal dilators were objectively analysed by means of 4-phase-Rhinomanometry. The study population were 24 people aged from 17 to 37 years old without serious health problems and without rhinological diseases.
Most of the users considered subjectively the Breathe Right (79%) and Airmax (21%) dilators to be the most comfortable in use and effective in improving nasal breathing. Nozovent and Nasanita nose Butterfly appeared to have approximately the same effectiveness, but turned out to be more uncomfortable for everyday use and had more side effects or provoced inconvenient feelings. In the objective part of the study Breath Right, Airmax and breathing without nasal dilator were compared by means of rhinomanometry. Both devices reduce resistance parameters compared with breathing without device in VR in, LVR, LReff In, LReff, LREEFtotal parameters. The Airmax is more effective than Breath Right reducing these resistance parameters.
Nasal dilators may reduce the nasal resistance remarkably, but the reduction of the nasal resistance depends on the nasal pathology. The best effect can be achieved in widening the nasal entrance, in particular in so called “valve phenomenon”. The effect is predictable by 4-phase-Rhinomanometry. The improvement is better in inspiration as in expiration, because the nasal valve reduces the inspiratory airflow. To exclude the influence of the nasal cycle, it is recommended to calculate the Total Nasal Resistance or measure the resistance by Active Posterior Rhinomanometry.
Nasal dilators are being developed for the purpose of increasing air flow in the nasal valve. The aim of this study is to evaluate the use of the internal nasal dilator (IND) by adolescent athletes.
Methodology
A double-blind, crossover clinical trial in which we evaluated 54 adolescents using treatment and placebo INDs, submitted to a cardio-respiratory 1000m race in randomized order. The predicted values for the peak nasal inspiratory flow (PNIF) were obtained and the intensity of dyspnoea was evaluated using the visual analogue scale method after the race.
In relation to PNIF (% predicted), when participants used the treatment IND, significantly higher means were found in comparison with the placebo (104.27±24.67 L/min and 97.73±25.61 L/min, respectively) (p=0.010). There were no significant differences observed in terms of heart rate (HR), pulse oximetry (SpO2) and maximal oxygen uptake (VO2max.), before and after the cardio-respiratory test. There was also no significant difference (p>0.05) between the use of treatment and placebo INDs on dyspnoea scale measurements after completion of the cardio-respiratory test.
Conclusion
Results suggested that the Airmax® IND improves nasal patency, as measured by PNIF, in healthy adolescent athletes. New studies should be conducted to evaluate the effect of IND in adolescent athletes with chronic diseases, such as asthma and allergic rhinitis, and also using other cardio-respiratory assessment methods.
To investigate the ease of use of four-phase high-resolution rhinomanometry (HRR), a new way of measuring nasal resistance, in measuring change in nasal resistance from supine to inclined position in a clinical sleep laboratory setting, and to correlate findings with continuous positive airway pressure (CPAP) tolerance
Forty successively seen Caucasian subjects diagnosed with sleep-disordered breathing (SDB) with complete charts were analysed. Using four-phase HRR and acoustic rhinometry, nasal resistance and minimal cross-sectional area of the nasal cavity were objectively measured with the patient in the supine position and repeated in the inclined position (30 degrees from the horizontal plane), respectively.
From the supine to inclined position, reduction in total nasal resistance was observed in 87,5% (35 out of 40). There was a mean reduction of nasal resistance by 37.1 +/- 21,6%. Five (12,5%) out of 40 subjects showed no change or mild increase in nasal resistance. Subjects with nasal resistance unresponsive to the inclined position change tended to have difficulty using nasal CPAP based on downloaded compliance card data.
Four-phase HRR and acoustic rhinometry are tests that can be easily performed by sleep specialists to characterize nasal resistance in SDB patients and determine changes in resistance with positional changes. In this study we found that patients who did not demonstrate a decrease in nasal resistance with inclined position were more likely to be noncompliant with nasal CPAP. These measurements may help us objectively identify patients who might have trouble tolerating nasal CPAP.
Dear Mr/Mrs,
I hereby state that the endonasal dilator Airmax° is a very useful non surgical therapeutic option for patients with nasal obstruction and/or snoring due to nasal valve pathology. Therefore, the Rhinologists in major university referral centers in Rhinology are recommending the use of Airmax° to their patients. In addition, Airmax° nasal dilators are being indicated for use by all patients seeking medical advice for nasal valve dysfunction with nasal obstruction and/or snoring at the European Rhinoplasty Course.
Patients with nasal valve problems often undergo surgery which mostly lead to inferior outcomes than can outcomes achieved by the nasal dilator Airmax°. In addition, Airmax° dilator is preferred by patients over other nose widening devices given the patient friendly and unique shape, and the significant improvement of nasal flow.
Only in case of dissatisfaction with a nasal dilator, surgical correction of the nasal valve can be carried out with successes largely depending on the degree of widening of the nasal valve within aesthetic limitations.
Yours sincerely,
Peter Hellings
Chairman of EUFOREA
The aim of the study is to evaluate the therapeutic efficacy of the intranasal dilator ‘Airmax’ on patients with snoring and OSAS.
In the evaluation both models of the Airmax (developed and manufactured in the Netherlands) were used . The devices provide simultaneous dilation of the nasal vestibule and anteroinferior segment of the nasal cavity. Such placement of the device causes the lateral displacement of the nasal alae and lateral walls of the nasal cavity together with the anterior portion of the inferior nasal turbinate. Said dilation offers the enlargement of the common nasal passage and the nasal valve and, hence, increases air flow whilst decreasing impedance produced by intranasal structures while breathing in.
The BREAS system (Sweden) was used to carry out respiratory monitoring (RM), both with and without intranasal dilators. All patients and their bed partners filled in a questionnaire to estimate the quality of sleep with and without the Airmax. Some patients were subjected to rhinomanometry (HRR 3 4-Phase-Rhinomanometer, Germany) and thermistography (developed by Airmax itself).
All patients were considered to manifest the following pathologies: provocative snoring and OSAS, as: hyperplasia of the palatal and lingual tonsils, micrognathia and deviation of nasal septum.
(Endovideorhinopharyngoscopy with functional probes carried out on patients lying on the back).
Considerable reduction of snoring (loudness and duration) was revealed in:
Stage I snorers in 29 cases.
Stage II snorers in 28 cases.
Stage III snorers in 25 cases.
In OSAS in 19 patients.
Very little effect was observed in patients with hyperplasia of the palatal and lingual tonsils, micrognathic patients, and in individuals with blocked posterior part of the nasal cavity (polyposis, fixed deformity of the ploughshare bone, hyperplasia of the posterior end of inferior turbinates).
The single use of the Airmax improves nasal breathing without surgery in several kinds of pathology in the front parts of the nasal cavity, the lower nasal shells and also the vestibule of the nose and can be used as non-invasive method to diminish the loudness and duration of essential stages of snoring (including pregnant women), and prevent the development of OSAS.
