Nasal pathologies in patients with obstructive sleep apnoea

Abstract

SUMMARYNasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway and aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSA patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swelling.

Evaluation of nasal symptoms in septoplasty patients using SNOT-22

“…Of the patients participating in the study, 100 (91%) completed both the pre- and post-operative questionnaires. This rate is higher than that in other studies (60-76%) 510 . The SNOT-22 was first used to evaluate chronic sinusitis 13 , and has also been used in sepsis 56 .…”

“…However, there are also reports of long-term complaints 9 . Lower concha surgery methods are frequently performed with septoplasty, which most frequently affect surgical outcome and improves the symptoms of nasal obstruction 10 . In the literature, there is no single, optimal inferior turbinate surgical method 11 .…”

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

“…In the short and long term, the most typical problems reported in these patients were dysphagia, rhinolalia, velopharyngeal insufficiency and nasopharyngeal regurgitation, phlegm in throat, and abnormal scarring with velopharyngeal stenosis [13][14][15][16]. Besides, the tissue resection required for these techniques caused a thick fibrotic scar on the palatal edge that, touching and abrading the base of the tongue, resulted in throat discomfort or foreign body sensation in the throat [17,20,21].…”

Evaluation of The Relationship of Nasal Septum Deviation With Pharyngeal Airway and Cervico-Craniofacial Measurements on Cephalometric Analysis

“…Impaired nasal breathing and its effect on the growth and development of the craniofacial structures and the dentition have been subject to study for decades. One of the possible physical obstacles is a deviated nasal septum which causes an increased nasal resistance and consequently altered normal nasal breathing [12]. When the predominant nasal breathing shifts to oral breathing, there happens a disturbance in the growth and development of orofacial structures [26].…”

“…NSD was 3.2%. Mode of breathing is closely related to the anatomical conditions of the nasal cavity such as NSD and hypertrophy of the inferior turbinates, although it cannot be ruled out that there will be other reasons like chronic rhinosinusitis, nasal in ammation, enlarged adenoids or other nasopharyngeal pathologies [12]. Mouth-breathing (may be somewhat considered as a misused term) is used to express oro-nasal respiration mode in the literature, since the total nasal obstruction is extremely rare in human beings [13].…”