鼻腔通気度の臨床検査への応用

鼻粘膜の腫脹・収縮による鼻腔通気度の変化についての検討

抄録

Rhinomanometry was executed for cases of nose and sinus disease under several conditions using the anterior method. Then application of rhinomanometry to routine clinical examination formed the subject of my study. Though the rhinomanometry is considered to be useful as an objective indication for nasal obstruction and the standardization of measuring method has so far progressed, we cannot safely say that full use has been made for general clinical tests, the reasons of which might be:
(1) Methods of measurement and expression have not been completely unified;
(2) Usefulness of rhinomanometry in routine clinical examination has not been clarified sufficiently;
(3) How to consider the congestion and decongestion of nasal mucosa remains unknown.
In order to deliberate such problematical points as above we made the following studies.
I. With a variety of nose and sinus diseases (90 cases) as subjects, 1 carried out the rhinomanometry before and after adrenalin spraying on nasal mucosa. As an expression method of rhinomanometry we used nasal resistanc and effective cross-sectional area (ECSA) and revealed the advantages and disadvantages of these two. Further we observed if there be any difference of decongestion of nasal mucosa between cases of respective diseases. Moreover we studied the relationship between the ECSA after adrenalin spraying and that after operation.
II. With 269 cases suspected of allergic rhinitis as the subjects, I worked out rhinomanometry when judging the results of provocation test. The reference for positive swelling of nasal mucosa was studied through two expression methods of nasal resistance and ECSA. Then I discussed the usefulness of combined use of rhinomanometry for judging the results of provoccation test. In addition, possible influences of age on the results of provocation test and nasal patency were studied.
III. In order to examine nasal cycle in cases of sinusitis, we observed the time-evolutive rhinomanometry with cases having lesions on hemilateral sinus as the subjects. The reason why I chose the hemilateral sinusitis is that I considered I could clarify the relationship between inflammation and nasal cycle by comparison on both sides of diseased and healthy. The results I could obtain are follows:
(1) For judging the change of congestion and decongestion of nasal mucosa, expression by ECSA was more suited than that by nasal resistance.
(2) For decongestion of nasal mucosa by adrenalin spraying into nasal cavity, a tendency to large was recognized in allergic rhinitis, but there was no significant difference between respective disease.
(3) ECSA after operation revealed a strong positive correlation with that after adrenalin spraying before operation.
(4) Combined use of rhinomanometry in judging the results of provocation test could reduce the false negative and increase the testing sensitivity.
(5) It has turned out a tendency that the ECSA increase with age, while the change of ECSA by provocation revealed decreasing trend with age. In particular for 60 years or more of age, there were many caces where ECSA does not change by provocation test through the patient complained of allergic rhinitis.
(6) In the 2 hours' rhinomanometry with hemilteral sinusitis as subjects, nasal cycle was recognized in 47% of chronic sinustis cases and 73% of acute sinusitis cases.
(7) The amplitude of the change in nasal resistance and ECSA by nasal cycle was larger in the acute sinusitis. In the acute sinusitis this tend was remarkable only on sick side, where the percentage was high of the cases in which swelling of nasal mucosa on sick side was larger in duration and degree than on the opposite side.
Rhinomanometry is useful for clinical examination. But for the correct judging, we must be careful with the problematical points as above.