Nasal Provocation and Eustachian Tube Function

Abstract

Nasal provocation, which has played an important role in defining the pathophysiology of nasal diseases has been applied to studying the pathophysiology of eustachian tube function and middle ear diseases. The development of rhinomanometry has provided an objectivity to the assessment of nasal airway obstruction. In addition, the utilization of computer technology to assist in data management has provided a new dimension to this procedure that has enhanced its potential. Recent advances in our understanding of eustachian tube physiology and its relationship to the nasopharynx, plus the documentation of eustachian tube obstruction after nasal provocation, have enhanced the utility of these procedures. This occurred in conjunction with the development of an additional methodology, sonotubometry, to objectively measure eustachian tube obstruction. The ability to perform computer-assisted rhinomanometry and sonotubometry in series and also in conjunction with pulmonary function testing to quantify almost simultaneously several parameters of upper and lower airway obstruction has expanded the usefulness of these procedures. The lack of standardization of the several challenge procedures currently utilized has limited the development of these procedures as clinical tools. At the present time nasal provocation testing is used primarily for clinical investigation because previous definitive studies have not correlated symptoms with test results. There is a need to reassess the clinical application of these procedures in light of the recently developed technology. These have not been adequately explored and have not yet been utilized to their maximum potential. As the methodologies are more refined it is anticipated that nasal provocation testing will play an increasingly important role in studying the pharmacology and management of the allergic response.