Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents

Abstract

Objectives: To standardize acoustic rhinometry (AR) in nasal provocation tests (NPTs) with histamine in children and adolescents. Patients and Methods: We performed a cross-sectional validation to compare AR with anterior active rhinomanometry (AAR) during histamine NPT in 20 children and adolescents with persistent allergic rhinitis and 20 controls. Changes in total nasal resistance (AAR) were compared with changes in nasal volume in the first 5 cm (V5 ; P=.04) at baseline. The mean histamine concentration necessary to increase total nasal resistance by at least 100% was significantly lower in the rhinitis group than in the control group (0.72 mg/mL vs 2.4 mg/mL; P<.001). At the end of the NPT a mean increase of 126% in total nasal resistance and a mean decrease of 24.3% in V5 were observed in the rhinitis group. When compared with the AAR criteria, the highest sensitivity and specificity values were observed for a cutoff represented by a 19%-21% drop in V5. Conclusions: We found AR to be a feasible and sensitive tool for monitoring nasal response in children and adolescents undergoing histamine NPT. The best AR cutoff for ending the NPT was a 19%-21% drop in V5. Key words: Rhinitis. Nasal provocation tests. Histamine. Acoustic rhinometry. Rhinomanometry. Nasal cavity. Airway resistance. ResumenObjetivos: Estandarizar la rinometría acústica (RA) como medida de la respuesta a la prueba de provocación nasal con histamina (PPN) en niños y adolescentes. Pacientes y métodos: Se realizó un estudio de validación transversal comparando la RA frente a la rinomanometría anterior (RAA) activa en la evaluación de la respuesta frente a la PPN con histamina, realizado en 20 niños o adolescentes, diagnosticados de rinitis alérgica persistente y 20 controles sanos. Las variables estudiadas fueron los cambios en la resistencia nasal total, medida mediante RAA y los cambios en el volumen nasal de los primeros 5 cm (V5) evaluados mediante RA. Resultados: En relación con los sujetos control, los pacientes con rinitis alérgica presentaban niveles basales de resistencia nasal total significativamente más elevados (medias respectivas 0,34 Pa/cm 3 /s versus 0,21 Pa/cm 3 /s; p= 0,01) y valores de V5 significativamente inferiores (medias respectivas 8,20 cm 3 versus 9,24 cm 3 ; p= 0,04). La concentración media de histamina necesaria para incrementar el 100% la resistencia total nasal fue significativamente más baja en los pacientes con rinitis que en los controles (medias respectivas 0,72 mg/ml versus 2,4 mg/ml; p< 0,001). Al final de la PPN el incremento medio de la resistencia nasal total fue del 126%, en los sujetos con rinitis alérgica. En ese momento también se observó en este grupo un decremento medio del V5 del 24,3%. Utilizando como patrón oro de respuesta positiva un incremento en la resistencia nasal total del 100% mediante RAA, los puntos de corte con mayor sensibilidad y especificidad para el descenso de V5 se encontraban en un descenso de entre el 19 y 21%. Conclusiones: Nuestros resultados demuestran que la RA es ...

Korean Modification of the Nasal Provocation Test With House Dust Mite Antigen Following the EAACI Guidelines

“…These results are also consistent with previous findings. In addition to our studies using acoustic rhinometry for NPT [ 2 , 8 - 11 ], Wandalsen et al [ 12 ] also found that acoustic rhinometry was an effective measure for NPT in adolescents and children. The current study is the first to perform the NPT according to the standardized protocol in the EAACI position paper and to measure the changes in these objective parameters.…”

Specific Nasal Provocation Test with Dermatophagoides Pteronyssinus, Monitored by Acoustic Rhinometry, in Children with Rhinitis

“…7–9 Recently, acoustic rhinometry was validated as a technique for monitoring NPT with histamine in children and adolescents, and compared it with the previous acoustic rhinomanometry. 10…”

“…[7][8][9] Recently, acoustic rhinometry was validated as a technique for monitoring NPT with histamine in children and adolescents, and compared it with the previous acoustic rhinomanometry. 10 One of the biggest obstacles to the implementation of specific NPT routine investigation and evaluation of patients with rhinitis symptoms is the high cost and test duration, both being directly proportional to the number of concentrations of the provocative agent used.…”

Comparative Effect of Beclomethasone Dipropionate and Cetirizine on Acoustic Rhinometry Parameters in Children With Perennial Allergic Rhinitis: A Randomized Controlled Trial

“…Nasal patency can be evaluated subjectively using symptom severity scales [4][5][6] or objectively using clinical measures [7], such as acoustic rhinometry, a validated noninvasive tool applied to measure the area and volume of the nasal cavity [8]. In children, measurement of volume in the anterior part of the nose has been shown to be sensitive for changes in nasal patency due to changes in mucosal swelling after the nasal provocation test [9] and after decongestion [10]. Nasal cytology can also be used for objective evaluation of mucosal inflammation and provides insights into the efficacy of therapeutic interventions [11,12].…”