Measurement of Nasal Obstruction: Rhinomanometry as Basic Method in Functional Rhinology

Abstract

Measuring nasal obstruction should be mandatory before every nasal surgery to determine necessary surgical steps and to separate the mucosal congestion from the skeletal deformity. Rhinomanometry is considered the “Golden Standard” for measuring the nasal airway resistance. An extension of the diagnostic power was achieved by the introduction of 4-phase-rhinomanometry 4PR, which does not only allow an additional information about the influence of the elasticity of the nasal wall. By introduction of logarithmic parameters also a high correlation to the subjective sensing of obstruction could be achieved. The parameters of 4PR could be classified by evaluating 36,500 measurements. The ISCOANA determined it as the new standard. Adding a VAS to every measurement is a documentation of the feeling of obstruction at the moment of measurement. Practical hints for 4PR are given. The determination of obstruction for both nasal sides or the calculation of the total nasal resistance should be followed by a second analysis of the detailed obstruction anatomy. In the future pressure losses or temperature gradients can be determined by Computational Fluid Dynamics (CFD). A reliable way to simulate the success of single surgical steps with a high didactical meaning is the 3D-print of sliced nose models and to measure the effect of stepwise mechanical corrections.