Protection of the Inferior Nasal Passage from Inspiration.

INTRODUCTION:

MATERIAL and METHOD  

We investigated 1000 patients, which regularly suffered from seasonal common  cold and 300 practically healthy persons, which suffered by common cold not more often, than once in 4 - 5 years. The age of the patients was from 2 till 86 years, of the men and women were approximately fifty-fifty (Tab. 1).  This table shows, that from the group with uniform distribution of air flows (50/50 CU) to in extreme groups with moving of  the main airstream to lower nasal passages up to 70 (CU) - 179,2 Pa. and  80 (CU) 204,8 Pa. the protective properties of a nose are gradually reduced and more aggressive display of catch a cold with its consequences (complications). As the distribution of air flows on an inspiration depends from property of the "physiological bridges", also moving of an air flow to a lower nasal passages is depends on changes in this area. For specification of these data we had carried the analysis of a status "physiological bridges" at these patients. We in addition surveyed 280 patients with uniform distribution of airstream  on inspiration (50/50 CU) between medial and lower nasal passages and their age was from 20 till 48 years, from them of the men were  212.  At an anterior rhinoscopy in this group of the patients  "physiological bridges" is kept, as well as at all practically healthy persons. However, the subsequent moving of airstream to lower nasal passage was already accompanied by appreciable  infringements in area of the nasal valve as well a slippage of the inferior turbinate with increase of a clearance connecting medial and lower nasal passages, that resulted in disappearance of the "physiological bridges". And the inferior turbinate bone on so much has decreased, that looked atrophic and corresponds to a "Southern type" of nasal aerodynamics. Hence, in process of a slippage of the inferior turbinate bone, the "physiological  bridges" gradually disappears and accordingly the protective properties of nasal aerodynamics loses. But in group of (50/50 CU), where these protective properties also decrease, visually to find out a slippage of the inferior turbinate bone it is not obviously possible. Therefore we continued to search for others, more latent of the reasons of such sharp downturn of protective properties of a nose to catch a cold. First of all, we have paid special attention to the lower nasal passage, as to most defenceless. It is quite obvious, that the mucosa of the lower nasal passage in the greatest degree suffers from an overload because it practically is unprotected from "harsh" air at inspiration. Only at expiration the warm and damp air way, as though tries to compensate this overload ( removes an irritation of a mucosa from an inspiration). But this indemnification is enough effective only in the summer period, and with a seasonal cold it is already unsufficient.  And as results in an overload of mucosa reaching a trauma of the lower nasal passage expressing in acute seasonal rhinitis. Hence, the lower nasal passages are programmed to be as a starting reason of development seasonal rhinitis.  And consequently, even the insignificant  displacement of an air flow on 10 (CU) in a lower nasal passage already becomes an overload for it. herefore, the regular seasonal catch a colds irrespective of the impression of complete differentiation of the lower and medial nasal passages with presence of the "physiological bridges", specify an overload of the lower passages as a result of infringements of a nasal aerodynamics. The similar patients we observed and in groups with more expressed displacement of an air flow in a lower nasal passages up to 20 and 30 (CU). To reveal such infringements in a nose at an anterior  rhinoscopy rather difficultly and only careful analysis of the mechanism of infringement of a nasal aerodynamics  allows to select for these patients the effective help. Such patients were 83 in the age of from 20 - till 50 years, of the men were 65. It more often (in 47 cases) we observed at a high position an inferior turbinate, when despite of division the lower and medial nasal passages, the main airstream at inspiration can not jump in a medial nasal passage and it as though fall down in a lower nasal passage (Fig. 1-1,2).   (Fig. 1-1,2).  

                                                           Fig. 1

                          1                                    2                                    3
 

In 30 cases of a high position an inferior turbinate we cracked a bone basis of its anterior department and then it displaced to bottom on so much (Fig. 1-2,3.), that the main airstream at inspiration has elevated in a medial nasal passage.  
In 19 of these cases the sizes of the inferior turbinate had appeared smaller and consequently after its displacement to bottom it simultaneously was removed from a nasal septum on so many that destroyed the "physiological bridges" (Fig. 2 - 1,2.). 

                                             Fig. 2                    Fig. 3

For a of restoration of the "physiological bridges" it was required in addition increase tissues in this area. With this purpose in 12 cases we had generated the new bridges (two-layers flap) between inferior turbinate and nasal septum - (Patent ¹ 2090156 - Fig. 2 - 1,7.), and in 7 cases we increased volume of inferior turbinate on a way  (Zain U. Kadri MD, Anaheim CA. "Reconstruction of inferior Turbinate" J. Otolaryng. H. N. S. 1998, p. 154-155), by an implantation in a mucosal "pocket"  of inferior turbinate a cartilage fragment of an auricle (Fig. 3 - 1,8.).  
The similar situation occurs and at a low position of a bottom (fundus) of a nasal vestibule  (absence a limen nasi - nasal riffle), when the main airstream at inspiration also fall down in the lower nasal passage. (Fig. 4- 1,2.),resulting to its overload.
 
It we observed in 36 cases at a medial position of the inferior turbinate. In 27 cases at a low position of a bottom of a nasal vestibule we carried out an implantation of a cartilage of an auricle in a mucosal "pocket" on bottom of a nasal vestibule (Patent ¹ 95110077), that allowed to generate a new limen nasi (nasal riffle) and with its help to lift an airstream at inspiration. It provided moving of an airstream in a medial nasal passage (Fig. 4 - 1,2,8).  
 
 

                                                          Fig. 4.

                 Conclusions:  

               1. Appearance of regular seasonal rhinitis, despite the presence of the physiological bridge", is indicative of impaired protective function of nasal   aerodynamics.  

               2. The even small  (10 CU - 25,5 Pa.) distribution of airstream in the inferior nasal passages at inspiration can lifts sensitivity below nasal passage to  
overloads in fall and winter, thus programming to be as a starting reason of  
development seasonal rhinitis.  

               3.  The excessively high position of the "physiological bridge" causes the "down-fall" of the airstream at inspiration into the lower nasal passage, which results in its overload and seasonal rhinitis. In such cases, to protect the inferior nasal passage from overloads, surgical shift is indicated of the inferior turbinate bone downwards with supplementary correction of the "physiological bridge" until the main airstream at inspiration is shifted to the medial nasal passage.  

               4. The extremely low position of the fundus of the nasal vestibule, even when the "physiological bridge" is present, causes the "down-fall" of the air flow at inspiration into the lower nasal passage, which results in its overload and seasonal rhinitis. In such cases, to protect the inferior nasal passage from overloads, surgical elevating is indicated of the fundus of the nasal vestibule until the main air flow is shifted into the medial nasal passage.  

              5. In fact it is necessary to recognize that the inferior nasal passage needs protection from the main airstream at inspiration, i.e. protection from inspiration.