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27

INTRODUCTION
Acoustic rhinometry (AR) evaluates the
geometry of the nasal cavity with acoustic
reflections and provides information about nasal
cross-sectional area and nasal volume within a
given distance into the nasal cavity. It is a
painless, noninvasive procedure that requires little
cooperation of the patients and has been applied
to both children and adults [1,2]. Yuan et al
introduced the acoustic rhinometer to evaluate
nasal patency in Taiwan [3]. Later, Liu et al
proved the technique useful for showing the
difference in nasal patency between normal adults
and patients with chronic hypertrophic rhinitis
Objectives. Acoustic rhinometry is used to objectively measure the minimal cross sectional area
and volumes of nasal cavities. However, data for healthy subjects reported in Taiwan are few.
Therefore, we wanted to establish the normal range among healthy adults and to evaluate the
changes after nasal decongestion.
Methods. We included 20 males and 25 females in this study (mean age: 25.1 years; age range: 19 to
40 years). An acoustic rhinometer was used to evaluate the first minimal cross sectional area
(MCA1), the distance from the tip of the probe to the first minimal cross sectional area (D1), the
second minimal cross sectional area (MCA2), the distance from the tip of the probe to the second
minimal cross sectional area (D2), the volume between the tip of the nosepiece and 3 cm into the
nasal cavity (V03), the volume of the nasal cavity between 2 to 5 cm from the tip of the
nosepiece (V25), the volume of the nasal cavity between 4 to 7 cm from the tip of the nosepiece
(V47), and the volume between the tip of the nosepiece and 7 cm into the nasal cavity (V07).
These measurements were taken before and after nasal decongestion.
Results. Data acquired from the male group before decongestion were as follows: MCA1: 0.74
0.12 (cm
2
); D1: 0.35 0.25 (cm); MCA2: 0.61 0.27 (cm
2
); D2: 2.30 0.29 (cm); V03: 2.38 0.45 (cm
3
);
V25: 3.73 1.64 (cm
3
); V47: 6.46 3.69 (cm
3
); V07: 10.19 4.43 (cm
3
); data acquired from the female
group before decongestion were: MCA1: 0.62 0.15 (cm
2
); D1: 0.56 0.43 (cm); MCA2: 0.67 0.28
(cm
2
); D2: 2.33 0.58 (cm); V03: 2.13 0.46 (cm
3
); V25: 3.93 2.16 (cm
3
); V47: 7.89 4.38 (cm
3
); V07:
11.48 5.48 (cm
3
). The increase in MCA2 after nasal decongestion was significant (p 0.001), both
in females and males. The increases in V03, V25, V47 and V07 after nasal decongestion were
statistically significant both in the female and male groups as well (p 0.001).
Conclusions. Acoustic rhinometry is a convenient method for assessing the geometry of the
nasal cavity. The maximal effect of decongestion is found in the anterior and middle part of the
nasal cavity, at the level of the inferior and middle turbinates. ( Mid Taiwan J Med 2003;8:27-31)
Key words
acoustic rhinometry, minimal cross sectional area, nasal decongestant, nasal volume
Received : October 8, 2002. Revised : November 21, 2002.
Accepted : November 22, 2002.
Address reprint requests to : Rong-San Jiang, Department of
Otolaryngology, Taichung Veterans General Hospital, 160 Sec. 3,
Taichung Harbor Road, Taichung 407, Taiwan.
Acoustic Rhinometry in Measuring Nasal
Volumes
Chih-Wen Twu, Rong-San Jiang
1
, Shan-Hen Wu
2
, Chen-Yi Hsu
1
Department of Otolaryngology, Chu-Tung Veterans Hospital, Hsin-Chu County;
1
Department of Otolaryngology,
Taichung Veterans General Hospital, Taichung;
2
Wei-En Clinics, Taichung, Taiwan.
ORIGINAL ARTICLE
[4]. However, there is no evidence in the literature
that acoustic rhinometer has been used to measure
nasal volumes after nasal decongestion.
Therefore, we defined the normal ranges for
nasal cross-sectional areas and volumes in 45
normal adults with acoustic rhinometer, both
before and after the application of 3%
phenylephrine hydrochloride.
MATERIAL AND METHODS
This study included 45 healthy adults (20
males and 25 females; age range: 19 to 40 years;
mean age: 25.1 years) selected from our staff and
medical student body. Exclusion criteria were as
follows: 1) obvious nasal deformity or septal
deviation, 2) history of prior trauma, nasal
operation, allergic rhinitis, nasal polyposis or
chronic rhinosinusitis, 3) current use of
medication that could influence the congestive
state of the nasal mucosa, and 4) recent upper
respiratory infections within two weeks prior to
the selection process.
The impulse acoustic rhinometer (GMI Ltd,
UK) used in this study has been described fully in
previous reports [3,5-8]. The room temperature
was kept between 20 and 25 C, and the relative
humidity was around 50% to 55%. All subjects
remained seated for at least 20 minutes to
acclimatize to the hospital environment before
testing [7]. The nose piece was positioned parallel
to the sagittal plane of the head and at 45 to the
coronal plane, and was applied to produce an
acoustic seal without distorting the outer nose.
The tested subjects were asked to hold their
breath and avoid swallowing while we acquired
the acoustic data. Changes in cross-sectional area
cause a portion of the energy to be reflected back
toward the wave tube and these reflections are
sensed by the microphone. Cross-sectional area
was computed from the intensity of the echo. The
data were converted to an area-distance function
and plotted on a semilogarithmic scale of area
(cm
2
) on the y-axis and distance (cm) on the x-
axis. Both nasal cavities of all subjects were
examined before and 15 minutes after 2 sprays of
3% phenylephrine hydrochloride solution were
applied to each nostril [9]. Three consecutive
readings were used to calculate an average value
for each data point. An entire average acoustic
rhinometry curve was generated for each nasal
cavity before and after decongestion. Acoustic
data included: 1) the first minimal cross sectional
area (MCA1), 2) the distance from the tip of the
probe to the first minimal cross sectional area
(D1), 3) the second minimal cross sectional area
(MCA2), 4) the distance from the tip of the probe
to the second minimal cross sectional area (D2),
5) the volume between the tip of the nosepiece
and 3 cm into the nasal cavity (V03), 6) the
volume of the nasal cavity between 2 and 5 cm
28 Acoustic Rhinometry
MCA1 (cm
2
)
0.74
(0.41
0.62
(0.30
0.67
(0.30
0.79
(0.57
0.64
(0.32
0.71
(0.32
0.12*
1.01)
0.15
0.90)
0.15
1.01)
0.11
1.12)
0.11
0.89)
0.14
1.12)
D1 (cm)
0.35
(0.10
0.56
(0.10
0.47
(0.10
0.32
(0.10
0.46
(0.20
0.40
(0.10
0.25
1.50)
0.43
1.80)
0.38
1.80)
0.17
0.70)
0.28
1.60)
0.24
1.60)
MCA2 (cm
2
)
0.61
(0.22
0.67
(0.20
0.64
(0.20
0.91
(0.48
1.49
(0.56
1.23
(0.48
0.27
1.64)
0.28
1.58)
0.28
1.64)
0.38**
2.58)
0.88***
3.57)
0.76
3.57)
D2 (cm)
2.30
(1.70
2.33
(1.70
2.32
(1.70
2.08
(1.70
2.71
(1.50
2.43
(1.50
0.29
3.40)
0.58
4.00)
0.47
4.00)
0.45
4.10)
0.99
4.50)
0.85
4.50
Table 1. MCA1, D1, MCA2 and D2, before and after nasal decongestion
*Arithmetic mean standard deviation (range); The increase in MCA2 was significant (p 0.001) after nasal
decongestion, both in males** and females***. N = numbers of nostrils; M = male; F = female; MCA1 = the first minimal
cross sectional area; MCA2 = the second minimal cross sectional area; D1 = the distance from the tip of probe to the first
minimal cross sectional area; D2 = the distance from the tip of probe to the second minimal cross sectional area.
Status
Before nasal decongestion
After nasal decongestion
Sex
M
F
Total
M
F
Total
N
40
50
40
50
29 Chih-Wen Twu, et al.
from the tip of the nosepiece (V25), 7) the
volume of the nasal cavity between 4 cm and 7
cm from the tip of the nosepiece (V47), and 8) the
volume between the tip of the nosepiece and 7 cm
into the nasal cavity (V07). Statistical calculations
were analyzed by paired t test.
RESULTS
The ranges, averages, and standard
deviation of MCA1, D1, MCA2, D2, V03, V25,
V47 and V07 before and after the application of
nasal decongestant are listed in tables 1 and 2.
The increases in cross sectional area after
application of nasal decongestant were 5% and
86% among MCA1 and MCA2, respectively. The
changes in V03, V25, V47 and V07 after
application of nasal decongestant were 42%,
70%, 36% and 41% respectively.
The changes in MCA1 after application of
nasal decongestant were not statistically
significant. However, the increase in MCA2
was significant ( p 0.001), both in females and
males. An increase in volume of nasal cavities
was noted in both female and male groups after
application of nasal decongestant ( p 0.001).
DISCUSSION
Acoustic rhinometry is relatively non-
invasive, simple, and requires less patient
cooperation than other methods. The technique is
appropriate for evaluating patients with no nasal
airflow (laryngectomy patient) and those with
total or near-total nasal obstruction. These groups
cannot be studied with rhinomanometry or peak
flow. However, in cases with severe nasal
obstruction, the acoustic rhinometry analysis of
the depths of the nose is unreliable. Also,
deviation of nasal septum and hypertrophy of
inferior nasal turbinates may influence the results
of acoustic rhinometry as well.
Our results cover a wide range of nasal
cavity volumes and equate with the normal range
in the healthy population. They suggest that
volumes vary widely between subjects. We found
a good correlation between values of left and
right nostrils with no overall marked lateral
asymmetry.
In this study, a significant increase in
MCA2 after nasal decongestion was noted both in
the male and female groups (p 0.001). Yet, the
change in MCA1 was not statistically significant.
We also found an increase in V03, V25, V47, and
V07 after nasal decongestion, both in the male
and the female groups.
The cavernous erectile tissue in the nasal
submucosa is most developed over the inferior
and middle turbinates and the septal cavernous
body [10]. Thus the greatest effect of
decongestion after receiving 3% phenylephrine
V03 (cm
3
)
2.38
(1.41
2.13
(1.16
2.24
(1.16
3.15
(2.24
3.20
(2.00
3.18
(2.00
0.45*
3.38)
0.46
3.50)
0.47
3.50)
0.58**
4.84)
0.68***
5.04)
0.64
5.04)
V25 (cm
3
)
3.73
(1.75
3.93
(1.90
3.84
(1.75
6.52
(2.91
6.53
(2.43
6.52
(2.43
1.64
7.65)
2.16
14.46)
1.94
14.46)
2.21**
15.17)
1.9***
12.73)
2.08
15.17)
V47 (cm
3
)
6.46
(1.84
7.89
(2.91
7.26
(1.84
9.69
(3.15
10.07
(4.56
9.90
(3.15
3.69
19.63)
4.38
28.64)
4.13
28.64)
3.94**
25.42)
2.86***
19.37)
3.37
25.42)
V07 (cm
3
)
10.19
(5.15
11.48
(5.57
10.91
(5.15
15.13
(6.99
15.62
(7.49
15.40
(6.99
4.43
25.34)
5.48
36.87)
5.06
36.87)
4.84**
34.57)
4.11***
28.70)
4.43
34.57)
Table 2. Volumes of nasal cavities before and after nasal decongestion
*Arithmetic mean standard deviation (range); The increase in V03, V25, V47 and V07 after nasal decongestion were
statistically significant both in male** and female*** groups ( p 0.001). N = numbers of nostrils; M = male; F = female;
V03 = the volume between the tip of the nosepiece and 3 cm into the nasal cavity; V25 = the volume of the nasal cavity
between 2 cm to 5 cm from the tip of the nosepiece; V47 = the volume of the nasal cavity between 4 cm to 7 cm from the
tip of the nosepiece; V07 = the volume between the tip of the nosepiece and 7 cm into the nasal cavity.
Status
Before nasal decongestion
After nasal decongestion
Sex
M
F
Total
M
F
Total
N
40
50
40
50
30 Acoustic Rhinometry
hydrochloride occurred in the anterior and middle
part of the nasal cavity. Data obtained in this
study also showed a significant increase in cross
sectional area among MCA2 (anterior portion of
inferior nasal turbinates) and a prominent increase
in volumes of the anterior portion (V03) and the
middle portion of the nasal cavity (V25). Our
measurements are compatible with previous
reports [11-14].
However, significant differences before and
after decongestion were noted on the posterior
portion of the nasal cavity (V47). These might
have been due to the following factors: 1)
interference from the contralateral nasal cavity
among the posterior portion of the tested side; 2)
underestimation of deeper areas and volumes due
to narrowing of the nose which produces a cross-
sectional area of 0.6–0.7 cm
2
[11,12,15]; 3)
distortion of the acoustic pulse after shrinkage of
mucosa of the middle and the inferior turbinate;
4) the accuracy of acoustic rhinometry which
diminishes with distance from the nostril [16-18];
5) leak of acoustic pulse into the paranasal
sinuses after the orifices are extended after
decongestion [19].
In conclusion, acoustic rhinometry is a
convenient method to assess the geometry of the
nasal cavity. This report studied the minimal cross
sectional area and volumes of nasal cavities in
normal healthy adults. The maximal effect of
decongestion was found in the anterior and
middle part of the nasal cavity, at the level of the
inferior and middle turbinates.
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31
1 2 1
1
2
45
(MCA1) (D1) (MCA2)
(D2) 3 (V03)
2 5 (V25) 4 7
(V47) 7 (V07)
20 25 19 40 25.1
MCA2 0.61 0.27 (cm
2
) D2 2.30 0.29 (cm) V03
2.38 0.45 (cm
3
) V25 3.73 1.64 (cm
3
) V47 6.46 3.69 (cm
3
) V07 10.19
4.43 (cm
3
) MCA2 0.67 0.28 (cm
2
) D2 2.33
0.58 (cm) V03 2.13 0.46 (cm
3
) V25 3.93 2.16 (cm
3
) V47 7.89 4.38
(cm
3
) V07 11.48 5.48 (cm
3
) MCA2
(p < 0.001) V03 V25 V47 V07
(p < 0.001)
2003;8:27-31
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