Rhinomanometry is a test of nasal function that measures air pressure and the rate of airflow in the nasal airway during respiration. These findings are used to calculate nasal airway resistance. Rhinomanometry is intended to be an objective quantification of nasal airway patency.

Acoustic rhinometry is a technique intended for assessment of the geometry of the nasal cavity and nasopharynx and for evaluating nasal obstruction. The technique is based on an analysis of sound waves reflected from the nasal cavities. Optical rhinometry utilizes an emitter and a detector placed at opposite sides of the nose and can detect relatice changes in nasal congestion by the change in transmitted light. This technique is based on the absorption of red/near-infrared light by hemoglobin and the endonasal swelling-associated increase in local blood volume.

The techniques are proposed for use in allergy testing, comparing decongestive action of antihistamines and corticosteroids, for evaluation of abstructive sleep apnea, and for assessment of the patient prior to nasal surgery.

Ten models of rhinomanometers or acoustic rhinometers have received marketing clearance by the U.S. Food and Drug Administration (FDA) 510(k) mechanism between 1984 and 2002. Optical rhinometry is a new technique that is being developed in Europe; at the time of the latest review no devices had received clearance for marketing in the U.S.

Rhinomanometry and acoustic/optical rhinometry are considered investigational.

BlueCard/National Account Issues

State or federal mandates (e.g., FEP) may dictate that all devices approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational, and thus these devices may be assessed only on the basis of their medical necessity.

2005 Update

A literature search was performed on the MEDLINE database for the period of 1997 through October 2005. The published literature did suggest that both acoustic manometry and rhinomanometry are frequently used in research studies in which objective measurements of nasal obstruction may be important to determine treatment effects. (1-11). However, no studies provided a detailed analysis of how these 2 diagnostic studies would be used in the clinical management of the patient and whether they were more clinically relevant or accurate compared to patient self-assessment. While patient self-assessment may be difficult in infants and small children (12, 13), data are insufficient to permit scientific conclusions in this population of patients. Acoustic rhinometry has also been investigated as a technique to measure nasal valve area. However, how this information may be used in the management of patients is unknown. (14)

2006-2007 Update

A search of the MEDLINE database for the period of September 2005 to December 2006 found no evidence to support a change in the policy statement. As described previously, rhinomanometry and acoustic rhinometry are frequently used as objective measurements of treatment efficacy in research studies. Use of acoustic rhinometry for the diagnosis of allergic rhinitis and surgical evaluation of nasal obstruction has been the topic of recent reviews. (15, 16) Pilot studies are also being reported for use of acoustic rhinometry in patients with obstructive sleep apnea to assess tolerance to nasal continuous positive airway pressure (CPAP). (17) However, no studies were found that demonstrate how use of these diagnostic procedures would improve outcomes compared to standard approaches, such as patient self-assessment. Therefore, the policy statement remains unchanged. 

2008 Update

A search of the MEDLINE database for the period of January 2007 through April 2008 did not identify any evidence that would alter the conclusions reached above. Several papers from Germany describe the development of optical rhinometry; one compared optical rhinometry with rhinomanometry using histamine, allergens, solvent and xylometazoline hydrochloride for nasal provocation in 70 normal subjects. (18) There was a higher correlation between subject's rating of nasal congestion and optical rhinometry ('r=0.84) than for rhinomanometry ('r= -0.69). Although this early work suggests that optical rhinometry may provide a quantitative measurement that is more similar to patient's assessment of nasal congestion that rhinomanometry, information on the clinical utility of these measurements is lacking. The impact of this technology on health outcomes is uncertain. Therefore, rhinomanometry and acoustic/optical rhinometry are considered investigational; the policy statement is unchanged.
 

References:

1. Schumacher MJ. Nasal congestion and airway obstruction: the validity of available objective and subjective measures. Curr Allergy Asthma Rep 2002; 2(3):245-51.
2. Larivee Y, Leon Z, Salas-Prato M et al. Evaluation of the nasal response to histamine provocation with acoustic rhinometry. J Otolaryngol 2001; 30(6):319-23.
3. Wilson AM, Sims EJ, Orr LC et al. Effects of topical corticosteroid and combined mediator blockade on domiciliary and laboratory measurement of nasal function in seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2001; 87(4):344-9.
4. Ellegard EK, Hellgren M, Karlsson NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol 2001; 26(5):394-400.
5. Rhee CS, Kim DY, Won TB et al. Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate. Laryngoscope 2001; 111(1):153-8.
6. Suzina AH, Hamzah M, Samsudin AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol 2003; 117(8):609-13.
7. Numminen J, Dastidar P, Heinonen T et al. Reliability of acoustic rhinometry. Respir Med 2003; 97(4):421-7.
8. Mamikoglu B, Houser SM, Corey JP. An interpretation method for objective assessment of nasal congestion with acoustic rhinometry. Laryngoscope 2002; 112(5):926-9.
9. Ceroni Compadretti G, Tasca I, Alessandri-Bonetti G et al. Acoustic rhinometric measurements in children undergoing rapid maxillary expansion. Int J Pediatr Otorhinolaryngol 2005; 70(1):27-34.
10. Ciprandi G, Marseglia GL, Klersy C et al. Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization. Allergy 2005; 60(7):957-60.
11. Nathan RA, Eccles R, Howarth PH et al. Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2005;115(3 pt 2):S442-59.
12. Priftis KN, Drigopoulos K, Sakalidou A et al. Subjective and objective nasal obstruction assessment in children with chronic rhinitis. Int J Pediatr Otorhinolaryngol 2005;70(3):501-5.
13. Djupesland P, Pedersen OF. Acoustic rhinometry in infants and children. Rhinol Suppl 2000; 16:52-8.
14. Cakmak O, Coskun M, Celik H et al. Value of acoustic rhinometry for measuring nasal valve area. Laryngoscope 2003; 113(2):295-302.
15. Corey JP. Acoustic rhinometry: should we be using it? Curr Opin Otolaryngol Head Neck Surg 2006; 14(1):29-34.
16. Uzzaman A, Metcalfe DD, Komarow HD. Acoustic rhinometry in the practice of allergy. Ann Allergy Asthma Immunol 2006; 97(6):745-51.
17. Morris LG, Setlur J, Burschtin OE et al. Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study. Am J Rhinol 2006; 20(2):133-7.
18. Wüstenberg EG, Zahnert T, Hüttenbrink KB et al. Comparison of optical rhinometry and active anterior rhinomanometry using nasal provocation testing. Arch Otolaryngol Head Neck Surg 2007; 133(4):344-9. 

Acoustic Rhinometry
Nasal Function Studies
Rhinomanometry