European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 10, pp 2617–2625 | Cite as

Critical evaluation of different objective techniques of nasal airway assessment: a clinical review

  • P. A. R. Clement
  • S. Halewyck
  • F. Gordts
  • O. Michel
Review Article


Objective tests for the nasal volume flow are needed for the assessment of nasal patency for diagnosis, documentation and medicolegal purposes. Three main techniques are nowadays established: active anterior rhinomanometry (AAR), 4-phase rhinomanometry (4PR) and acoustic rhinometry (AR). Several guidelines and consensus reports and the International Committee on Standardization have clarified the field of interest and the limitations of this technology. In the meantime, technical progress and the development of seemingly new methods have brought up many new facts which necessitate the re-evaluation of the test available. From our method of critical analysis we can conclude that AAR can be still considered as the standard technique for the objective assessment of the nasal airway. AR is a valid technique with limitations and cannot replace AAR because it measures different parameters thus forming a complementary technique. 4PR might provide supplementary information although not yet all open technical and mathematical inconsistencies conjoint with this technique have been clarified. Still the individual subjective sensations of the patient do not always match the objective measurements. In conclusion, a combination of information given by the patient, the rhinoscopic findings and the carefully interpreted results of AAR and AR will increase considerably the success of surgical interventions and the feeling of satisfaction by the patient after surgery, when matched thoughtfully.


Rhinomanometry Rhinometry 4-Phase rhinomanometry assessment 


  1. 1.
    Sipilä J, Suonpää J, Laippala P (1994) Sensation of nasal obstruction compared to rhinomanometric results in patients referred for septoplasty. Rhinology 32(3):141PubMedGoogle Scholar
  2. 2.
    Hardcastle P, Haacke N, Murray J (1985) Observer variation in clinical examination of the nasal airway. Clin Otolaryngol Allied Sci 10(1):3–7PubMedCrossRefGoogle Scholar
  3. 3.
    Glatzel W (1901) Zur Prüfung der Luftdurchgängigkeit der Nase. Ther Gegenw 42:348–351Google Scholar
  4. 4.
    Zwaardemaker H (1889) Ademaanslag als diagnosticum der nasale stenose. Ned Tijdschr Geneeskd 1:267Google Scholar
  5. 5.
    Willemot J (1981) Rhinologie. Pharyngologie in naissance et développement de l’oto-rhino-laryngologie dans l’histoire de la médecine. BEL 35:11–200Google Scholar
  6. 6.
    Spiess G (1900) Die Untersuchungsmethoden der Nase und ihrer Nebenhöhlen. In: Handbuch der Laryngologie und Rhinologie, Bd. III (Hrsg. Heymann, P.), S. 215–260. Hölder, WienGoogle Scholar
  7. 7.
    Melon J (1964) Physiopathologie générale de la muqueuse nasale. La ventilation nasale. Acta Oto Rhino Laryngol Belg 18:148–155Google Scholar
  8. 8.
    Bruck F (1901) Zur Prufung der Luftdurchgangigkeit der Nase. Ther Gegenw 42:407Google Scholar
  9. 9.
    Masing H (1965) Die klinische Bedeutung der Nasenwiderstandsmessung. Eur Arch Otorhinolaryngol 185(2):763–767CrossRefGoogle Scholar
  10. 10.
    Cottle M (1968) Rhino-sphygmo-manometry: an aid in physical diagnosis. Int Rhinol 6(1/2):7–26Google Scholar
  11. 11.
    Miller MR, Pincock AC (1986) Linearity and temperature control of the Fleisch pneumotachograph. J Appl Physiol 60(2):710–715PubMedGoogle Scholar
  12. 12.
    Fleisch A (1925) Der Pneumotachograph; ein Apparat zur Geschwindigkeitsregistrierung der Atemluft. Pflüger’s Archiv für die gesamte Physiologie des Menschen und der Tiere 209(1):713–722CrossRefGoogle Scholar
  13. 13.
    Cole P, Fenton RS (2006) Contemporary rhinomanometry. J Otolaryngol 35(2):83–87PubMedCrossRefGoogle Scholar
  14. 14.
    Nakano T (1967) Influence of nozzles on pressure and flow measurement studied by means of the artificial nose and the conductivity meter. Rhinolo Int 5:183–196Google Scholar
  15. 15.
    Fischer R (1969) Die Physik der Atemsströmung in der Nase. Habilitationsschrift. Hausdruckerei des Klinikum Steglitz der Freien Unviersitat Berlin, BerlinGoogle Scholar
  16. 16.
    Bachmann W (1982) Rhinomanometrische Untersuchungen. In: Die Funktionsdiagnostik der behinderten Nasenatmung, Teil II. Springer-Verlag, pp 113–141Google Scholar
  17. 17.
    Clement P (1984) Committee report on standardization of rhinomanometry. Rhinology 22(3):151PubMedGoogle Scholar
  18. 18.
    Mlynski G, Löw J (1993) Die Rhinoresistometrie—eine Weiterentwicklung der Rhinomanometrie. Laryngorhinootologie 72(12):608–610PubMedCrossRefGoogle Scholar
  19. 19.
    Cole P, Havas T (1987) Nasal resistance to respiratory airflow: a plethysmographic alternative to the face mask. Rhinology 25(3):159–166PubMedGoogle Scholar
  20. 20.
    Canbay EI, Bhatia SN (1997) A comparison of nasal resistance in white Caucasians and blacks. Am J Rhinol 11(1):73–75PubMedCrossRefGoogle Scholar
  21. 21.
    Carney A, Bateman N, Jones N (2000) Reliable and reproducible anterior active rhinomanometry for the assessment of unilateral nasal resistance. Clin Otolaryngol Allied Sci 25(6):499–503PubMedCrossRefGoogle Scholar
  22. 22.
    Gammert C, Hampl K, Herrmann P (1988) Beitrag zu den Normwerten in der Rhinomanometrie. HNO Hals Nasen Ohrenärzte 36(10):399–405Google Scholar
  23. 23.
    Dinis PB, Guerra J, Gomes A (1994) Sequential clinical comparison between two commercially available rhinomanometers. Acta Otolaryngol 114(3):435–442CrossRefGoogle Scholar
  24. 24.
    McCaffrey T (1990) Rhinomanometry and nasal resistance. Facial Plast Surg: FPS 7:266–273CrossRefGoogle Scholar
  25. 25.
    Roithmann R, Cole P, Chapnik J, Shpirer I, Hoffstein V, Zamel N (1995) Acoustic rhinometry in the evaluation of nasal obstruction. Laryngoscope 105(3):275–281PubMedCrossRefGoogle Scholar
  26. 26.
    Sipilä J, Suonpää J, Silvoniemi P, Laippala P (1995) Correlations between subjective sensation of nasal patency and rhinomanometry in both unilateral and total nasal assessment. ORL 57(5):260–263PubMedCrossRefGoogle Scholar
  27. 27.
    André R, Vuyk H, Ahmed A, Graamans K, Nolst Trenité G (2009) Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 34(6):518–525PubMedCrossRefGoogle Scholar
  28. 28.
    Unno T, Naitoh Y, Sakamoto N, Horikawa H (1986) Nasal resistance measured by anterior rhinomanometry. Rhinology 24(1):49–55PubMedGoogle Scholar
  29. 29.
    Zapletal A, Chalupova J (2002) Nasal airflow and resistance measured by active anterior rhinomanometry in healthy children and adolescents. Pediatr Pulmonol 33(3):174–180PubMedCrossRefGoogle Scholar
  30. 30.
    Szucs E, Kaufman L, Clement P (1995) Nasal resistance—a reliable assessment of nasal patency? Clin Otolaryngol Allied Sci 20(5):390–395PubMedCrossRefGoogle Scholar
  31. 31.
    Clement P, Kaufman L, Rousseeuw P (1983) Active anterior rhinomanometry in pre-and postoperative evaluation, use of Broms’ mathematical model. Rhinology 21(2):121PubMedGoogle Scholar
  32. 32.
    Broms P (1982) Rhinomanometry. Acta Otolaryngol 94:157–168PubMedCrossRefGoogle Scholar
  33. 33.
    Sipilä J, Suonpää J (1997) A prospective study using rhinomanometry and patient clinical satisfaction to determine if objective measurements of nasal airway resistance can improve the quality of septoplasty. Eur Arch Otorhinolaryngol 254(8):387–390PubMedCrossRefGoogle Scholar
  34. 34.
    Holmstrom M (2010) The use of objective measures in selecting patients for septal surgery. Rhinology 48(4):387–393PubMedGoogle Scholar
  35. 35.
    Pirila T, Tikanto J (2009) Acoustic rhinometry and rhinomanometry in the preoperative screening of septal surgery patients. Am J Rhinol Allerg 23(6):605–609CrossRefGoogle Scholar
  36. 36.
    Vogt K (1986) Einführung in die Rhinomanometrie. Humboldt University, BerlinGoogle Scholar
  37. 37.
    Vogt K (2000) High resolution rhinomanometry. In: Jahnke K (ed) 4th Eufos Congress Berlin. Monduzzi editore, pp 113–114Google Scholar
  38. 38.
    Clement P, Gordts F (2005) Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 43(3):169–179PubMedGoogle Scholar
  39. 39.
    Vogt K, Jalowayski AA, Althaus W, Cao C, Han D, Hasse W, Hoffrichter H, Mosges R, Pallanch J, Shah-Hosseini K, Peksis K, Wernecke KD, Zhang L, Zaporoshenko P (2010) 4-phase-rhinomanometry (4PR)—basics and practice 2010. Rhinol Suppl 21:1–50PubMedGoogle Scholar
  40. 40.
    Bridger G, Proctor D (1970) Maximum nasal inspiratory flow and nasal resistance. Ann Otol Rhinol Laryngol 79(3):481–488PubMedGoogle Scholar
  41. 41.
    Gross TF, Peters F (2011) A fluid mechanical interpretation of hysteresis in rhinomanometry. ISRN Otolaryngol (126520):1–6. doi: 10.5402/2011/126520
  42. 42.
    Schroeder M (1967) Determination of the geometry of the human vocal tract by acoustic measurements. J Acoust Soc Am 41:1002PubMedCrossRefGoogle Scholar
  43. 43.
    Hilberg O, Jackson A, Swift D, Pedersen O (1989) Acoustic rhinometry: evaluation of nasal cavity geometry by acoustic reflection. J Appl Physiol 66(1):295–303PubMedGoogle Scholar
  44. 44.
    Djupesland PG, Qian W, Furlott H, Rotnes JS, Cole P, Zamel N (1999) Acoustic rhinometry: a study of transient and continuous noise techniques with nasal models. Am J Rhinol 13(4):323–329PubMedCrossRefGoogle Scholar
  45. 45.
    Fisher E (1997) Acoustic rhinometry. Clin Otolaryngol Allied Sci 22(4):307–317PubMedCrossRefGoogle Scholar
  46. 46.
    Lenders H, Pirsig W (1992) Acoustic rhinometry: a diagnostic tool for patients with chronic rhonchopathies. Rhinol Suppl 14:101PubMedGoogle Scholar
  47. 47.
    Tomkinson A, Eccles R (1998) Acoustic rhinometry: an explanation of some common artefacts associated with nasal decongestion. Clin Otolaryngol Allied Sci 23(1):20PubMedCrossRefGoogle Scholar
  48. 48.
    Grymer LF, Hilberg O, Pedersen O, Rasmussen T (1991) Acoustic rhinometry: values from adults with subjective normal nasal patency. Rhinology 29(1):35–47PubMedGoogle Scholar
  49. 49.
    Szucs E, Clement PA (1998) Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patients with nasal septal deviation. Am J Rhinol 12(5):345–352PubMedCrossRefGoogle Scholar
  50. 50.
    Larsson C, Millqvist E, Bende M (2001) Relationship between subjective nasal stuffiness and nasal patency measured by acoustic rhinometry. Am J Rhinol 15(6):403–405PubMedGoogle Scholar
  51. 51.
    Pirila T, Tikanto J (2001) Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment. Am J Rhinol 15(2):127–133PubMedCrossRefGoogle Scholar
  52. 52.
    Grymer LF, Hilberg O, Pedersen OF (1997) Prediction of nasal obstruction based on clinical examination and acoustic rhinometry. Rhinology 35(2):53–57PubMedGoogle Scholar
  53. 53.
    Reber M, Rahm F, Monnier P (1998) The role of acoustic rhinometry in the pre- and postoperative evaluation of surgery for nasal obstruction. Rhinology 36(4):184–187PubMedGoogle Scholar
  54. 54.
    Naito K, Miyata S, Saito S, Sakurai K, Takeuchi K (2001) Comparison of perceptional nasal obstruction with rhinomanometric and acoustic rhinometric assessment. Eur Arch Oto-rhino-laryngol: Off J Eur Fed Oto-rhino-laryngol Soc 258(10):505–508CrossRefGoogle Scholar
  55. 55.
    Wilson AM, Fowler SJ, Martin SW, White PS, Gardiner Q, Lipworth BJ (2001) Evaluation of the importance of head and probe stabilisation in acoustic rhinometry. Rhinology 39(2):93–97PubMedGoogle Scholar
  56. 56.
    Silkoff PE, Chakravorty S, Chapnik J, Cole P, Zamel N (1999) Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects. Am J Rhinol 13(2):131–135PubMedCrossRefGoogle Scholar
  57. 57.
    Hamilton JW, McRae RD, Jones AS (1997) The magnitude of random errors in acoustic rhinometry and re-interpretation of the acoustic profile. Clin Otolaryngol Allied Sci 22(5):408–413PubMedCrossRefGoogle Scholar
  58. 58.
    Hilberg O (2002) Objective measurement of nasal airway dimensions using acoustic rhinometry: methodological and clinical aspects. Allergy 57(Suppl 70):5–39PubMedCrossRefGoogle Scholar
  59. 59.
    Sorensen H, Solow B, Greve E (1980) Assessment of the nasopharyngeal airway. A rhinomanometric and radiographic study in children with adenoids. Acta Otolaryngol 89(3–4):227–232PubMedCrossRefGoogle Scholar
  60. 60.
    Pedersen O, Hilberg O, Berkowitz R, Yamagiwa M (1994) Nasal cavity dimensions in the newborn measured by acoustic reflections. Laryngoscope 104(8):1023–1028PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • P. A. R. Clement
    • 1
    • 2
  • S. Halewyck
    • 1
    • 2
  • F. Gordts
    • 1
    • 2
  • O. Michel
    • 1
    • 2
  1. 1.Dienst KNOUniversitair Ziekenhuis Brussel (UZB)BrusselBelgium
  2. 2.Vrije Universiteit Brussel (VUB)BrusselBelgium

Personalised recommendations