Abstract
Measuring nasal obstruction should be mandatory before every nasal surgery to determine
the necessary surgical steps and to separate mucosal congestion from skeletal deformity.
Rhinomanometry is considered the “golden standard” for measuring nasal airway resistance.
An extension of the diagnostic power was achieved by the introduction of the four-phase
rhinomanometry (4PR), which provides additional information about the influence of
the elasticity of the nasal wall. Also, a high correlation to the subjective sensing
of obstruction could be achieved by the introduction of logarithmic parameters. The
parameters of 4PR could be classified by evaluating 36,500 measurements. The International
Standardization Committee on the Objective Assessment of the Upper Airway (ISCOANA)
determined it as the new standard. Adding a visual analog scale (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 three-dimensional (3D) print of sliced nose models and to measure the effect of
stepwise mechanical corrections.
Keywords
nasal obstruction - rhinomanometry - CFD simulation - 3D models
