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The Laryngoscope

Lippincott Williams & Wilkins, Inc., Philadelphia
© 2001 The American Laryngological,
Rhinological and Otological Society, Inc.
Accuracy of Acoustic Rhinometry
Measurements
Ozcan Cakmak, MD; Hu¨ seyin Celik, PhD; Tan Ergin, MD; Levent Sennaroglu, MD
Objectives: To identify the factors that influence
the accuracy of acoustic rhinometry measurements
recorded with commercially available equipment.
Study Design: A simple model was used which con-
sisted of a metal pipe and cylindrical inserts. These
inserts comprised various lengths, and aperture di-
mensions were comparable to, or smaller than, the
nasal valve areas of both adults and children. Meth-
ods: Accuracy of the acoustic rhinometry technique
was evaluated by comparing the measured and actual
cross-sectional areas. The results were discussed in
terms of the calculated acoustic transmission, reflec-
tion, and attenuation coefficients of the pipe model
variations. Results: Reducing the inner diameter of
the insert increased the degree of measurement er-
ror. As the length of the insert was increased, the
measured cross-sectional area gradually decreased,
approaching the actual area of the experimental pas-
sageway. For larger inserts, level of error was not
highly dependent on passageway length compared
with the narrower inserts. Conclusion: Our results
show that both the cross-sectional area and passage-
way length of the narrow segment are the most sig-
nificant factors that influence the accuracy in acous-
tic rhinometry measurements. Key Words: Acoustic
rhinometry, accuracy, nasal valve.
Laryngoscope, 111:587–594, 2001
INTRODUCTION
For decades, rhinologists have been trying to find an
objective means of assessing the nasal airway that can be
applied to a broad spectrum of patients. Recently, Hilberg
et al.
1
introduced acoustic rhinometry (AR) as a useful tool
for measuring the dimensions of the nasal cavity.
Acoustic rhinometry analyses soundwaves that are
reflected within the nasal cavity. Acoustic pulses, which
are generated by a spark, pass through the wave tube and
enter the nasal passage through the nosepiece of the AR
device. The sound is reflected as the waves impact struc-
tures in the passage. These reflected waves are detected
by a microphone and are then amplified, low-pass-filtered,
and digitized. Finally, the processed data are converted
into an area–distance plot using a computer.
1
Acoustic rhinometry is a quick, painless, noninva-
sive, and reliable method that can be performed easily and
requires minimal patient cooperation. It is potentially
useful for characterizing the geometry of the nasal cavity,
for quantifying the dimensions of nasal obstructions, and
for assessing results of surgery and response to medical
treatment. However, certain factors inherent to the phys-
ics and hardware involved in the technique affect the
accuracy of AR. Although this new method has been
widely used in clinical trials, to date only a few studies
have investigated its limitations.
2,3
If a clinical examina-
tion is done without considering these limitations, the
data can easily be misinterpreted.
Our aim in this study was to identify factors that influ-
ence the accuracy of AR measurements recorded with com-
mercially available equipment. To carry out the investiga-
tion, we used a simple model consisting of a metal pipe that
was fitted with cylindrical inserts of varied lengths and
varied aperture dimensions, the latter being comparable to
those of the human nasal valve. The results are discussed in
terms of the calculated acoustic transmission, reflection, and
attenuation coefficients of the pipe model variations.
THEORY
The AR instrument we used is capable of producing and
detecting soundwaves in the frequency range of 100 to 10,000 Hz.
A 10-kHz low-pass filter was used to limit the highest frequency.
The speed of sound in air at 20°C and at atmospheric pressure is
approximately 34,300 cm/s; therefore, the shortest wavelength (␭)
produced by the AR instrument is 3.43 cm. The cross-sectional
area of the nasal airway should be smaller than ␭
2
; therefore,
when analyzing AR measurements, there is no need to consider
diffraction and interference effects. In other words, AR works on
the basis of the rules of reflection. In the section below, we
express the transmission and reflection coefficients of sound-
waves propagated in two different media. We then apply these
expressions to the reflection, transmission, and attenuation coef-
ficients for soundwave propagation in cylindrical pipes. Finally,
we consider how these formulae apply to the experimental AR
results.
Presented at “The Nose 2000...And Beyond” in Washington, DC,
September 20–23 2000.
From the Otorhinolaryngology Department (O.C., T.E.), Bas¸kent Uni-
versity Faculty of Medicine, Adana Dr. Turgut Noyan Hospital, Adana,
Turkey; and the Departments of Physics (H.C.) and Otorhinolaryngology
(L.S.), Hacettepe University, Beytepe, Ankara, Turkey.
Editor’s Note: This Manuscript was accepted for publication January
16, 2001.
Send Correspondence to Ozcan Cakmak, MD, Bestekar Sokak, No: 70/C,
06680, Kavaklidere, Ankara, Turkey. E-mail: Ozcakmak@hotmail.com
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
587
Transmission and Reflection of Soundwaves at
the Interface Between Two Fluids
The general expressions for the sound power transmission
(a
t
) and reflection (a
r
) coefficients for plane acoustic waves trav-
elling from one fluid medium to another at normal incidence to
the interface are given by
4,5
:
a
t
ϭ 1 Ϫ a
r
ϭ 4R
1
R
2
/͑R
1
ϩ R
2
͒
2
(1)
where R
1
ϭ p
1
c
1
and R
2
ϭ p
2
c
2
are the characteristic impedances
of the two media; p
i
and c
i
are density of media and speed of
sound, respectively.
The characteristic impedances of air and water can be taken
as 430 kgm
-2
s
-1
and 1.5 ϫ 10
6
kgm
-2
s
-1
, respectively. By substi-
tuting these values into Equation 1, the values of 0.001 and 0.999
can be obtained for a
t
and a
r
. The transmission coefficient for
plane acoustic waves passing from a gas into a solid is approxi-
mately 10
-4
, and that froma gas to a liquid is roughly 10
-3
(i.e., the
reflection coefficients at the air/liquid and air/solid interfaces are
essentially equal to one). Therefore, a solid surface and a liquid
surface both act as a reflecting mirror for acoustic waves of
normal incidence. This indicates that nasal fluid will influence
AR measurements. In other words, if a viscous fluid covers the
walls of the nasal passage, the measured cross-sectional area will
indicate that the canal is narrowed.
Transmission and Reflection of Soundwaves
Traveling Through Cylindrical Pipes
The model variations used in the present work were con-
structed from a cylindrical brass pipe (Fig. 1). The cross-sectional
areas and lengths of the inserts were chosen in line with the actual
dimensions of the human nasal cavity, and with the dimensions of
similar inserts that have been used by other investigators.
2,3
For all the models used in this work A
1
ϭ A
3
ϭ 1.131 cm
2
,
whereas the cross-sectional area A
2
and the length b of the inserts
are taken to be variable. The transmission coefficient (a
t
) and the
reflection coefficient (a
r
) for plane acoustic waves propagating
through a three-stage pipe of cross-sectional areas A
1
, A
2
, and A
3
are given by
4,6
:
a
t
ϭ 1 Ϫ a
r
ϭ
4
͑ A
3
/A
1
ϩ 1͒
2
Cos
2
͑2␲fb/c͒ ϩ͑ A
2
/A
1
ϩA
3
/A
2
͒
2
Cos
2
͑2␲fb/c͒
(2)
where f is the frequency and c is the speed of sound in air.
The transmission coefficient a
t
as obtained from Equation 2
is plotted in Figure 2 as a function of frequency. The results
obtained for a
t
of models with different values of A
2
are shown on
the same diagram. The illustration shows that, for the inserts
with a small cross-sectional area, the transmission coefficient of
high-frequency sound waves is small. These results clearly indi-
cate that relatively higher degrees of error will be expected when
measuring inserts of a smaller cross-sectional area.
To study the variation of the transmission coefficient with
cross-sectional area A
2
, it is necessary to calculate the average of
a
t
over the frequency range provided by the AR instrument, using
a
t
͑ A
2
͒ ϭ
1
9900
͵
100
10000
a
t
͑ A
2
, f ͒df (3)
All calculations were made using Mathcad8 mathematical soft-
ware (Mathead 2000 Professional, Mathsoft Inc., USA). The re-
sults obtained for a
t
(A
2
) are shown in Figure 3. The transmission
coefficient increases as the cross-sectional area of the insert en-
larges. It should be noted that the behavior is approximately
linear at small values of A
2
, whereas there is a deviation from
linearity at higher values of A
2
, and the relationship tends to
saturate when A
2
ϭ A
1
ϭ A
3
.
Measurements were also made as a function of the length b
of the insert by taking its cross-sectional A
2
as a parameter. To
compare the calculated results with the experimental data, it is
necessary to calculate the average of the transmission coefficient
results over the AR frequency:
a
t
͑b͒ ϭ
1
9900
͵
100
10000
a
t
͑b, f ͒df (4)
Figure 4 shows the transmission coefficient a
t
as a function of b
for chosen values of A
2
. For small values of A
2
, the transmission
coefficient first rapidly declines, but then levels off and shows a
shoulder at bХ1.7 cm. For larger values of A
2
, a
t
(b) exhibits a
wide and shallow minimum, the location of which shifts to
smaller b as A
2
increases. Although the cross-sectional area of the
passage A
2
is fixed, the initial decrease of the transmission coef-
ficient with increasing insert length would yield a measured
value of A
2
which is lower than the actual value. These results
show that length of passage constriction affects accuracy when
measuring cavities with small cross-sectional areas.
Fig. 1. The dimensions of the model
pipe apparatus, which consisted of three
cylindrical parts. The left end is con-
nected to the nosepiece of the acoustic
rhinometer. The length and diameter of
each part are shown. Here A1 ϭ A3 ϭ
1.131 cm
2
; A2, ai, bi, and xi are variable.
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
588
Absorption of Soundwaves Within Cylindrical
Pipes
Soundwaves lose energy as they pass through a medium.
The losses that occur as a result of internal friction and heat
conduction in a viscous boundary layer attenuate the soundwaves
travelling in a pipe.
4,7
The intensity of the attenuated sound wave
can be expressed by
I ϭ I
o
exp(Ϫ2␣x) (5A)
where I
o
is the initial intensity of the sound wave, ␣ is the
attenuation coefficient, and 2x is the distance travelled through
the pipe by the wave. The attenuation coefficient ␣ (in units of
neper/m) of a soundwave in a cylindrical pipe is a function of both
wave frequency and pipe diameter:
␣ ϭ
2
ac
ͱ
␲␩f

(5B)
Fig. 2. The transmission coefficient as a
function of the frequency of sound-
waves. Each curve is labeled with the
diameter (ai) of the insert aperture (a2 ϭ
0.2 cm, a3 ϭ 0.3 cm, a4 ϭ 0.4 cm, a5 ϭ
0.5 cm, a6 ϭ 0.6 cm, a7 ϭ 0.7 cm, a8 ϭ
0.8 cm, a9 ϭ 0.9 cm, a10 ϭ 1.0 cm).
Fig. 3. The frequency-average of the
transmission coefficient versus the
cross-sectional area A2 of the insert
aperture.
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
589
Here ␩, a, c, f, and ␳ are the shear viscosity coefficient, diameter
of the pipe, speed of sound, wave frequency, and density of air
in the pipe, respectively. Using these values, ␩ ϭ 3.5 ϫ 10
-5
kgm
-1
s
-
1, c ϭ 343 ms
-1
, and ␳ ϭ 1.21 kgm
-3
for dry air at 20°C,
Equation 5B can be written as ␣ ϭ 5.52 ϫ 10
-5
͌ / a.
The attenuation coefficient of soundwaves travelling in air
is proportional to the square of frequency, a ϭ 2 ϫ 10
-11 2
. For
soundwaves of 10 kHz frequency propagating in air at standard
conditions ␣ ϭ 0.002 neper/m, whereas for soundwaves of the
same frequency travelling in an air-filled tube ␣ ϭ 0.55 neper/m.
To interpret the experimental data, it is necessary to calcu-
late the average of the relative intensity (I/I
0
) over frequencies
from 100 to 10,000 Hz using:
I/I
0
ϭ ͑1/9900͒
͵
100
10000
exp(Ϫ11 ϫ10
Ϫ5
ϫ ͱf/a)df (5C)
A value of 0.75 is obtained for the average relative intensity
of the reflected soundwaves in a pipe 1 cm in diameter and 20 cm
long. In other words, the energy of the reflected soundwave de-
creases by 25%. In principle, AR measures the intensity of the
reflected soundwave and converts the results to yield the cross-
sectional area of the pipe. According to the above calculations, if
the attenuation of soundwaves in the nasal airway is not taken
into account, the cross-sectional area measured by AR would be
consistently overestimated.
Experimental Procedure
A transient signal acoustic rhinometer (Ecco Vision, Hood
Instruments, Pembroke, MA) was used to perform the acoustic
measurements. In this particular rhinometer, the processed
bandwidth was in the frequency range of 100 to 10,000 Hz.
9
A
simple metal pipe of 1.2 cm inner diameter and 12 cm in length
was used for all the experiments. Measurements were taken
using 72 cylindrical metal inserts incorporating nine different
inner diameters (a
i
ϭ 0.2 cm, 0.3 cm, 0.4 cm, 0.5 cm, 0.6 cm, 0.7
cm, 0.8 cm, 0.9 cm, and 1.0 cm) and eight different lengths (b
i
ϭ
0.25 cm, 0.50 cm, 0.75 cm, 1.0 cm, 1.25 cm, 1.5 cm, 1.75 cm, and
2.0 cm). The distance (x
i
) from the nosepiece of the rhinometer to
the insert was adjusted precisely (Fig. 1). The different variations
of the model were designed so there was secure contact between
the model and the nosepiece of rhinometer to prevent acoustic
leakage, and all AR measurements were repeated at least five
times to ensure that the results were reproducible. The collected
data were analyzed and plotted using Origin software (version
6.0; Micrococal Software Inc., USA). We evaluated the accuracy of
the AR technique by comparing the measured and actual cross-
sectional areas of the inserts of different aperture size and pas-
sage length. The percentage error for each individual measure-
ment was calculated using
Error ϭ
ͩ
measured area Ϫactual area
actual area
ͪ
ϫ100 (6)
EXPERIMENTAL RESULTS
We found that the AR measurements varied accord-
ing to where the opening of the insert was located inside
the edge of the pipe. Measurements were taken with ap-
erture of the cylindrical insert placed at x
1
ϭ 2 cm, x
2
ϭ 4
cm, x
3
ϭ6 cm, and x
4
ϭ8 cm from the front end of the pipe
at x ϭ 0 (see Fig. 1). Figure 5A and B shows the results of
AR measurements obtained with insert apertures located
at x
1
ϭ 2 cm and x
4
ϭ 8 cm inside the pipe. We analyzed
the data obtained for inserts with apertures of various
diameters placed at different locations in the pipe, and
calculated the error in the measured cross-sectional area
according to aperture size using Equation 6. The percent-
age error calculated for selected insert locations is plotted
in Figure 5C as a function of the actual cross-sectional
area. This graph shows that there was a high degree of
error when inserts with small cross-sectional area were
measured, and that the magnitude of the error was not
Fig. 4. The frequency-average of the
transmission coefficient versus the
length b of the insert. Each curve is la-
beled with the diameter (ai) of the insert
aperture (a2 ϭ 0.2 cm, a3 ϭ 0.3 cm, a4
ϭ 0.4 cm, a5 ϭ 0.5 cm, a6 ϭ 0.6 cm, a7
ϭ0.7 cm, a8 ϭ0.8 cm, a9 ϭ0.9 cm, a10
ϭ 1.0 cm).
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
590
highly dependent on insert aperture location. The relative
intensity of the reflected sound waves (Equation 5C) trav-
elling in a pipe 1.2 cm in diameter and 6 cm in length was
0.964. This shows that there is an approximately 4% dif-
ference between the results of measurements when the
aperture is placed at x
i
ϭ 2 cm and x
i
ϭ 8 cm inside the
pipe.
Intensity measurements were also made using in-
serts with apertures of fixed diameter but variable length
located at a given position in the pipe. Figure 6A and B
shows the measurement results at two selected aperture
diameters and various insert lengths. The area-versus-
distance curve, which corresponds to the measured cross-
sectional area (A
2
) of the aperture, exhibits a deep trough.
As the length of the insert is increased, the measured
cross-sectional area gradually decreases, approaching the
actual area of the experimental passageway. Further in-
crease in the length of the insert to more than approxi-
mately 1.75 cm produces the start of a second trough,
which corresponds to a marked increase in the acoustic
transmission coefficient (Fig. 4).
We calculated the level of error in the measured
values of A
2
; Figure 6C shows the distribution of error for
selected insert lengths as a function of actual area A
2
.
There was a large degree of error in the measurements for
small-area inserts. For inserts of length b Ͼ0.75 cm, we
found that error was essentially independent of b for in-
sert areas greater than approximately 0.2 cm
2
. In other
words, when the experimental passageway of a large
cross-sectional area was measured, error did not change
significantly as insert length changed (Fig. 4).
When we applied a gelatinous material to the inner
wall of the inserts, the measurements reflected a narrow-
ing of the lumen. The extent of the observed effect was
dependent on the amount of material applied (Fig. 7).
DISCUSSION
Since Sondhi and Gopinach
9
first described acoustic
pulse-response analysis in 1971, studies have shown that
it is difficult to quantify cross-sectional areas distal to a
narrow aperture using AR. The calculation of each area
data point depends on the result of more proximal area
calculations because of marching algorithms.
10
Acoustic
pulses lose power as they contact and pass through nar-
rowed regions, and this makes it difficult to assess the
actual areas of the more posterior sections of the nasal
passages. This is potentially problematic because the nar-
rowest part of the nasal passage, the nasal valve area, is
located in the anterior portion of the nasal cavity.
1,2
For-
tunately, the nasal valve region is the most important part
of the nasal passage in terms of its role in respiratory
physiology and is of most interest to the rhinologist.
11,12
Fig. 5. (A) Insert cross-sectional area and the measured area by AR
as a function of aperture location inside the pipe. The insert is
placed at xi ϭ 2 cm from the left end of the pipe. The different
symbols refer to datasets collected for different aperture diameters
for insert length b ϭ 1 cm. (B) Measured area by AR as a function of
aperture location inside the pipe. The insert is placed at xi ϭ 8 cm
from the left end of the pipe. The different symbols refer to datasets
collected for different aperture diameters for insert length b ϭ 1 cm.
(C) Percentage error in the measurements of area A2. The different
symbols refer to datasets generated by different insert locations
inside the pipe.
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
591
Minimal changes in the cross-sectional area of the
nasal valve can produce significant changes in nasal re-
sistance.
13
Any method used to assess this key region is of
little value if it is not accurate. The normal range for area
in the nasal valve region in adults is 0.4 to 0.6 cm
2
, and in
6-year-old children it is 0.21 Ϯ 0.05 cm
2
.
14–16
In this
study, the areas of the cylindrical inserts used approxi-
mate, or are smaller than, the nasal valve areas of adults
and children (range, 0.031–0.875 cm
2
). This will allow
imitation of the normal anatomy and pathologies of this
region.
Hamilton and colleagues
3
highlighted some factors
that limit the accuracy of AR. They constructed a simple
tube model in which the main cylinder remained constant
and an insert of fixed length (1 cm) with a constricted area
was modified to represent areas of 0.07 to 0.95 cm
2
. These
authors found that AR measurements of versions with
larger minimal cross-sectional areas (greater than 0.4
cm
2
) had less than a 10% error, and that the level of error
rose gradually as the degree of constriction increased, to a
maximum error of 40% for the smallest cross-sectional
area measured. Buenting et al.
2
also investigated the ac-
curacy of AR measurements by inserting cylindrical in-
serts of 1-cm length and 2 to 9 mm inner diameter within
a simple rigid pipe model. Similar to the findings of Ham-
ilton and coworkers, they found that when the diameter of
the aperture was less than 6 mm (area ϭ 0.28 cm
2
), the
measured area was overestimated by 10%.
In our study, when 1-cm long inserts were measured,
the result was less than 10% error for actual cavity areas
larger than 0.385 cm
2
, and up to 70% error for an actual
passageway area of 0.071 cm
2
. As this indicates, the de-
gree of error was high when we measured passages with
small cross-sectional areas (i.e., passages of small aper-
ture size). The measured cross-sectional area depends on
the transmission coefficient (Fig. 3), with a decrease in the
intensity of transmitted soundwaves corresponding to a
decrease in the cross-sectional area. The transmission co-
efficients of high-frequency soundwaves are small for pas-
sageways of a small cross-sectional area (Fig. 2). This
relationship clearly explains the source of the relatively
higher degrees of error that are generated when measur-
ing small-area passageways. The transmission coefficient
increases nonlinearly as the cross-sectional area of the
passage expands (Fig. 3). The nonlinear behavior of the
transmission coefficient must be considered in the AR
algorithm.
Hamilton et al.
3
found that actual passage areas
were underestimated in all except the tightest construc-
tions, whereas Buenting and colleagues
4
found that larger
Fig. 6. (A) Measured area by AR as a function of the insert length.
The insert is placed at xi ϭ 2 cm from the left end of the pipe. Here,
insert cross-sectional area A2 ϭ 0.031 cm
2
. The different symbols
refer to datasets generated from different aperture diameters of
insert length b. (B) Measured area by AR as a function of the insert
length. The insert is placed at xi ϭ2 cm from the left end of the pipe.
Here, insert cross-sectional area A2 ϭ 0.636 cm
2
. The different
symbols refer to datasets collected for different aperture diameters
of insert length b. (C) Percentage error in the measurements of
cross-sectional area A2. Here bi is the length of the insert.
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
592
cavity areas were consistently underestimated and
smaller ones were always overestimated. In contrast to
both of these reports, our findings indicated that the cross-
sectional areas of these experimental passageways are
always overestimated by the AR technique. The overesti-
mations in our study can be explained by the absorption of
soundwaves that occurs within cylindrical pipes. As a
rule, soundwaves lose some of their energy as they travel
through a medium. In their study using human central
airway casts, Jackson et al.
17
found that internal energy
losses introduced negligible error. However, based on the
theoretical considerations and the results obtained in our
work, we conclude that this attenuation significantly af-
fects the accuracy of AR measurements. Specifically, the
loss in the intensity of the reflected waves leads to over-
estimation of the cross-sectional area of the nasal airway.
Therefore, the attenuation of soundwaves within pipes
should also be considered in the AR algorithm.
The use of a wave tube of a different internal diam-
eter (1.2 cm in our study, 1.3 cm and not specified in other
studies
2,3
) could also explain some of the disparity be-
tween the results of the various studies that have been
done. In principle, the diameter (a) of the wave tube
should not exceed (/1.7 (ϭ c/1.7f). Below this frequency, it
is reasonable to picture the air motion as being parallel to
the pipe axis, but at higher frequencies soundwaves follow
a zigzag path as they travel down the pipe.
18
The relative
intensity of soundwaves depends on both the diameter
and length of the wave tube (see Equation 5A) and also on
the position of the receiving microphone. Thus, the dimen-
sions of the wave tube and the location of the microphone
used in the investigations are important factors as well.
Buenting et al.
2
noted that when the aperture of the
insert was narrower, it was necessary to lengthen the
cylinder to preserve the accuracy of measure of the cross-
sectional area. In our study, we used inserts of fixed di-
ameter but variable length (b) to clarify what is occurring
in this effect. As the length of the insert is increased, the
measured cross-sectional area gradually decreases to the
point where it approaches the actual cross-sectional area
of the experimental passageway. For inserts of lengths
greater than 0.75 cm, the error is essentially independent
of b for areas above roughly 0.2 cm
2
(Fig. 6C). This obser-
vation can be explained by considering that the transmis-
sion coefficient varies with the length of the constricted
passage. In our work, as experimental insert length in-
creased, the transmission coefficient first dropped
sharply, then increased slightly, and eventually stabilized
(Fig. 4). While the transmission coefficient depends
greatly on the length of the insert with a smaller cross-
sectional area, this relationship is weak when passage-
ways of a larger area are measured. For larger inserts,
level of error is less influenced by passageway length,
whereas for narrow inserts, measurement error increases
as the passageway becomes shorter (Fig. 4). Our results
concur with those of Buenting and colleagues,
2
and indi-
cate that length of the insert is one of the main influences
on AR accuracy. This is of particular importance in the
pediatric population in which, depending on the length
and cross-sectional area of the nasal valve region, the
examiner should expect less accurate AR measurements.
The same consideration applies to cases of nasal pathology
that involve extreme narrowing and shortening of the
passageway, especially the nasal valve area. For example,
measurements taken in patients with severe septal devi-
ation, polyps, and web or stricture of the anterior nasal
cavity would involve a higher magnitude of error.
The error resulting from viscous losses has also been
identified as a limiting factor in AR measurements.
8
Our
findings indicated that application of gelatinous material
mimicked narrowing of the tube, and that the degree of
the effect paralleled the amount of substance that was
Fig. 7. The variation in insert area when
a gelatinous material was applied to the
inner wall of the model.
Laryngoscope 111: April 2001 Cakmak et al.: Acoustic Rhinometry Measurements
593
added (Fig. 7). This result is in line with the fact that
liquids act as a mirror for sound waves (see Equation 1). It
follows that to obtain more accurate measurements, the
nasal cavity should be cleared of nasal secretions before
AR examination.
CONCLUSION
The anatomy of the human nose is complex, and the
amount of space in the nasal cavity can vary greatly. The
accuracy of AR measurements is highly dependent on
nasal passage anatomy, especially that of the narrowest
section, and on the specifications of the AR instrument
used. Our results show that cross-sectional area and pas-
sageway length are the factors that most significantly
influence accuracy in AR. These two parameters should be
considered together when estimating error in AR findings.
When the cross-sectional area and length of the narrowest
part of the passage are relatively small and short, respec-
tively, there is a higher probability of measurement error.
Every clinician who uses AR equipment should be aware
of the factors that affect the accuracy of these measure-
ments, because results from many patients may include
considerable error. Although the method is potentially
useful in practice, there is also risk of misinterpretation.
The results of the model calculations presented in
this work suggest that there is a need for further improve-
ment in the design of AR equipment and related computer
software.
Acknowledgment
The authors thank Prof. Dr. M. Cankurtaran for his
valuable consultation and his critique of the manuscript.
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