nasal breathing - buteyko clinic · influence on quality of life and can affect the stomatognathic...
TRANSCRIPT
Nasal Breathing
PATRICK MCKEOWN MA
ButeykoCliniccom
bull The physiologic breathing mode in the human being is nasal regardless of
age
bull Any factor leading to the upper airway (UA) obstruction causes nasal
breathing to be replaced by mouth breathing among which mechanical
events allergic and nonallergic inflammatory diseases congenital
malformation and tumoral lesions
bull Brant TCS Parreira VF Mancini MC Becker HMG Reis AFC Brito RR Breathing pattern and thoracoabdominal motion in mouth-breathing children Rev Bras Fisioter 200812(6)495-501
Nasal Breathing
To identify the prevalence of mouth breathing in children at primary
school ages from 6-9 years researchers in Portugal examined 496
answered questionnaires from parents It was found that 568 of
children in this study breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
Nasal Breathing
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table until 370 had
been enrolled this number had been determined by statistical calculation
bull 370 children enrolled Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth breathers
Abreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr
(Rio J)2008 Sep-Oct84(5)467-70
Nasal Breathing
150 children in the sample with ages ranging from 8 to 10 years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3 minutes
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull The physiologic breathing mode in the human being is nasal regardless of
age
bull Any factor leading to the upper airway (UA) obstruction causes nasal
breathing to be replaced by mouth breathing among which mechanical
events allergic and nonallergic inflammatory diseases congenital
malformation and tumoral lesions
bull Brant TCS Parreira VF Mancini MC Becker HMG Reis AFC Brito RR Breathing pattern and thoracoabdominal motion in mouth-breathing children Rev Bras Fisioter 200812(6)495-501
Nasal Breathing
To identify the prevalence of mouth breathing in children at primary
school ages from 6-9 years researchers in Portugal examined 496
answered questionnaires from parents It was found that 568 of
children in this study breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
Nasal Breathing
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table until 370 had
been enrolled this number had been determined by statistical calculation
bull 370 children enrolled Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth breathers
Abreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr
(Rio J)2008 Sep-Oct84(5)467-70
Nasal Breathing
150 children in the sample with ages ranging from 8 to 10 years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3 minutes
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
To identify the prevalence of mouth breathing in children at primary
school ages from 6-9 years researchers in Portugal examined 496
answered questionnaires from parents It was found that 568 of
children in this study breathed through their mouth
bull Felcar Jm Bueno Ir Massan Ac Torezan Rp Cardoso Jr Prevalence of mouth breathing in children from an elementary school Cien Saude Colet2010 Mar15(2)437-44
Nasal Breathing
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table until 370 had
been enrolled this number had been determined by statistical calculation
bull 370 children enrolled Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth breathers
Abreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr
(Rio J)2008 Sep-Oct84(5)467-70
Nasal Breathing
150 children in the sample with ages ranging from 8 to 10 years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3 minutes
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Randomized sample of the towns population (23596 inhabitants)
bull Children were selected by lots according to a random number table until 370 had
been enrolled this number had been determined by statistical calculation
bull 370 children enrolled Clinical assessment carried out
bull 55 of the children involved in the study were found to be mouth breathers
Abreu RR Rocha RL Lamounier JA Guerra AF Prevalence of mouth breathing among children J Pediatr
(Rio J)2008 Sep-Oct84(5)467-70
Nasal Breathing
150 children in the sample with ages ranging from 8 to 10 years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3 minutes
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
150 children in the sample with ages ranging from 8 to 10 years
two tests were carried out
bull test 1- breathe steam against a mirror
bull test 2 - water remains in the mouth with lips closed for 3 minutes
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Mouth breathing prevalence was of 533 There was no significant
difference between gender age and type of breathing
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Facial alterations were incomplete lip closure (588 X 57) fallen eyes
(400 X 14) High palate (388 X 29) Anterior open bite (600
Versus 300) Hypotonic lips (38 X 00) Circles under the eyes (975
Versus 771)
bull Valdenice Aparecida De Menezesa Rossana Barbosa Lealb Rebecca Souza Pessoac Ruty Mara E Silva Pontesd Prevalence and factors related to mouth breathing in school children at the Santo Amaro project-Recife 2005 Brazilian Journal of Otorhinolaryngology Volume 72 Issue 3 MayndashJune 2006 Pages 394ndash398
Nasal Breathing
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Oral deleterious habits are often called harmful or parafunctional and
include thumb sucking bottle feeding tongue thrusting nail biting lip
biting and the mouth- breathing pattern These habits have direct
influence on quality of life and can affect the stomatognathic system of
the body bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
51 of the children are involved in one or more than one oral harmful
habits and the finding are in agreement with the results of Gildasya et al in
children aged 6-12 years Where as Motta LJ et al found preschoolers with
874 habits Lower prevalence had been reported by Quashie-Williams
as 341 in school going children Shetty et al (1998) and Kharbanda et al
(2003) observed prevalence as 297 amp 255 respectively in south and
north Indian children bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Bhayya DP et al found tongue thrusting and mouth breathing as the most
prevalent oral habits bull J B Garde Rajendra K Suryavanshi Bhushan Arun Jawale Vikramsingh Deshmukh Dattaprasad P Dadhe Maneesha
Kshirsagar Suryavanshi An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children Journal of International Oral Health 2014 6(1)39-43
Nasal Breathing
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull A questionnaire was given to parentsguardians at 13 nurseries in
Tokushima City There were 468 valid responses (452) We defined a
subject as a mouth breather in daytime (MBD) if they had 2 or more
positive items among the 3 following items ldquobreathes with mouth
ordinarilyrdquo ldquomouth is open ordinarilyrdquo and ldquomouth is open when
chewingrdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
We defined subjects as mouth breathers during sleep (MBS) if they had 2
or more positive items among the following 3 items ldquosnoringrdquo ldquomouth is
open during sleepingrdquo and ldquomouth is dry when your child gets uprdquo
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
The prevalences of MB Day and MB Sleep were 355 and 459
respectively There were significant associations between MBD and atopic
dermatitis
bull Association between Mouth Breathing and Atopic Dermatitis in Japanese Children 2ndash6 years Old A Population-Based Cross-Sectional Study Harutaka Yamaguchi et al 27 2015 httpdxdoiorg101371journalpone0125916
Nasal Breathing
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Functions of
the nose
PATRICK MCKEOWN MA
ButeykoCliniccom
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Dr Maurice Cottle who founded the American Rhinologic Society in
1954 your nose performs at least 30 functions all of which are
important supplements to the roles played by the lungs heart and
other organs
Timmons BH Ley R Behavioral and Psychological Approaches to Breathing Disorders 1st ed
Springer 1994
Nasal Breathing
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Mouth breathing has been studied since the beginning of the twentieth
century with scientific publications directed to the scope of dentistry
emphasizing the occlusal consequences
bull Hartsook JT Mouth breathing as a primary etiologic factor in the production of malocclusion J Dent Child
194613(4)91-4
Nasal Breathing
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
To evaluate diaphragmatic amplitude (DA) in nasal and mouth-breathing
adults The study evaluated 38 mouth-breathing (MB group) and 38 nasal-
breathing (NB group) adults from 18 to 30 years old and both sexes
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Mouth breathing reflected on lower recruitment of the accessory
inspiratory muscles during fast inspiration and lower diaphragmatic
amplitude compared to nasal breathing
Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth breathing
adults a cross-sectional study 2015 Journal of electromyography and kinesiology 25 463-468
Nasal Breathing
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Nasal Breathing
bull Pharyngeal airway
dimensions are higher in
nasal-breathers than mouth-
breathers
bullInternational Journal of Pediatric Otorhinolaryngology 75 (2011) 1195ndash1199
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Mouth breathers show cognitive impairment as well as attention deficit
hyperactive disorder (memory concentration attention learning
disability low perception and sensorimotor integration) It has been shown
that children with excessive day time sleepiness appear to have almost 10
times the risk of learning difficulties
bull Sao Paulo Med J 2014 Sep 26
Nasal Breathing
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Oral breathing modifies head position The significant increase of the
craniocervical angles in patients with this altered breathing pattern suggests an
elevation of the head and a greater extension of the head compared with the
cervical spine
bullBreathing pattern and head posture changes in craniocervical angles Minerva Stomatol 2015 Apr 64(2)59-74
Nasal Breathing
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Respiratory biomechanics and exercise capacity were negatively affected by Mouth
Breathing
bull The presence of moderate forward head position acted as a compensatory
mechanism in order to improve respiratory muscle function
bullJ Bras Pneumol 2011 Jul-Aug 37(4)471-9 Mouth breathing and forward head posture effects on respiratory biomechanics and exercise capacity in children
Nasal Breathing
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Nasal Resistance amp
Breath Holding
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Recent studies have suggested that the inhalation of cold air through the
nose is associated with the subsequent release of mediators of immediate
hypersensitivity
Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull To determine if mucosal surface heat and water loss influence the nasal
functional response to cold air we measured nasal resistance by posterior
rhinomanometry
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull During the challenge period the subjects breathed either in and out
of the nose or in through the nose and out through the mouth
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull No changes in nasal resistance developed when subjects breathed
exclusively through the nose
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to challenge with
cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull However when subjects breathed in through the nose and out
through the mouth nasal resistance was increased 200 at 1 min
(P less than 001) after the challenge and returned to baseline
values by 10 min after cessation of the challenge
bull Strohl KP Arnold JL Decker MJ Hoekje PL McFadden ER Nasal flow-resistive responses to
challenge with cold dry air J Appl Physiol (1985) 1992 Apr72(4)1243-6
Nasal Breathing
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull To compare the difference in respiratory water loss during expiration
through the nose and through the mouth in healthy subjects
bull The study included 19 healthy non-smoking volunteers without any
present history of non-infectious rhinitis presenting with symptoms of
rhinitis asthma or previous nasal surgery
Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull This study showed that the net water loss increased by 42 when the
breathing mode was switched from nasal to oral expiration during tidal
breathing in healthy subjects Increased water and energy loss by oral
breathing could be a contributing factor to the symptoms seen in patients
suffering from nasal obstruction
bull Svensson S1 Olin AC Hellgren J Increased net water loss by oral compared to nasal expiration in healthy subjects Rhinology 2006 Mar44(1)74-7
Nasal Breathing
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull The response of nasal airway resistance (Rn) to various degrees of hypoxia
and hypercapnia was measured in six subjects using active posterior mask
rhinomanometry
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Hypercapnia induced by breathing gas mixtures of various contents of
carbon dioxide significantly decreased Rn The reduction in Rn was
proportional to the inspired partial pressure of carbon dioxide over a
range of 0 to 50 torr
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Breathing gas mixtures of high and low contents of oxygen produced no
significant change in Rn These results indicate that the nasal airway is
actively involved in the respiratory response to hypercapnia but not to
moderate hypoxia
bull Ann Otol Rhinol Laryngol 1979 Mar-Apr88(2 Pt 1)247-52 Response of nasal airway resistance to hypercapnia and hypoxia in man McCaffrey TV Kern EB
Nasal Breathing
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull A group of 51 patients were studied to assess the influence of breath
holding hyperventilation and exercise on nasal resistance It was found
that holding of the breath for 30 seconds or longer helped to open up the
nose to make breathing easier in most of the subjects tested
Furthermore it was found that physical exercise also decreased nasal
resistance
Hasegawa M Kern EB The effect of breath holding hyperventilation and exercise on nasal resistance Rhinology 1978 Dec16(4)243-9
Nasal Breathing
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Posterior mask rhinomanometry was used to measure nasal resistance
during exercise and hypercapnia in 10 healthy adult volunteers Exercise
was produced by peddling a stationary bicycle at three loads Hypercapnia
was produced by breathing O2 mixtures containing 5 6 and 8 CO2
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull The results showed that nasal resistance decreases linearly as expired CO2
levels and exercise levels increase
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull The constant relationship between nasal resistance and minute ventilation
during hypercapnia and exercise suggests that nasal resistance is regulated
by the respiratory center to match the level of respiratory demand
bull Otolaryngol Head Neck Surg 1984 Jun92(3)302-7 Role of the nasal airway in regulation of airway resistance during hypercapnia and exercise Second-Place Resident Award at 1982 Research Forum
Nasal Breathing
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Results suggested that breath holding increased the nasal
volume due to shrinkage of nasal membrane promptly and
evenly within the nasal cavity
bull 誘発鼻腔粘膜収縮の解析
bull 旭川医科大学耳鼻咽喉科
bull 高橋竜二榎本啓一今田正信
bull 野中聡海野徳二
bull The effect of breath holding on nasal membrane
bull shrinkage analyzed by acoustic rhinometry
Nasal Breathing
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Nasal airway resistance was decreased during breath
holding in man and during experimentally induced asphyxia
in animals
bull Tatum AL (1923) The effect of deficient and excessive pulmonary ventilation on nasal
volume Am J Physiol 65 229-233
Nasal Breathing
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull When nasal breathing takes place in the presence of
significant obstruction there is an increase in FCO2 a
decrease in FO2 and a decrease in nasal airway resistance
In other words when nasal breathing is forced to push
against significant obstruction the effect of this obstruction
appears to be that of decreasing the nasal resistance
bull Arch Otorhinolaryngol (1988) 245 112-115
Nasal Breathing
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Temporomandibular
(TMD)
PATRICK MCKEOWN MA
ButeykoCliniccom
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Neck accessory respiratory muscles and mouth breathing suggest a direct
relationship among asthma Temporomandibular (TMD) and Cervical Spine
(CSD) Disorders This study was performed to evaluate and correlate TMD
CSD in asthmatic and non-asthmatic
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Thirty asthmatic children (71 plusmn 26 years old) 30 non-asthmatic
predominantly mouth breathing children (Mouth Breathing Group - MBG)
(880 plusmn 161 years) and 30 non-asthmatic predominantly nasal breathing
children (Nasal breathing Group ndash NBG) (900 plusmn 164 years) participated in
this study and they were submitted to clinical index to evaluate
stomatognathic and cervical systems
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Significant frequency of palpatory tenderness of temporomandibular joint
(TMJ) TMJ sounds pain during cervical extension and rotation palpatory
tenderness of sternocleidomastoids and paravertabrae muscles and a
severe reduction in cervical range of motion were observed in AG
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of
temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent
200529(4)287-92
Nasal Breathing
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull Both AG and MBG groups demonstrated palpatory tenderness of posterior
TMJ medial and lateral pterygoid and trapezius muscles when compared
to NBG Results showed a positive correlation between the severity of
TMD and CSD signs in asthmatic children (r = 048)
bull Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
bull No child was considered normal to CSD and cervical mobility The possible
shortening of neck accessory muscles of respiration and mouth breathing
could explain the relationship observed between TMD CSD signs in
asthmatic children and emphasize the importance of the assessment of
temporomandibular and cervical spine regions in asthmatic children
Chaves TC Grossi DB Oliveira AS Bertolli F Holtz A Costa D Correlation between signs of temporomandibular (TMD) and cervical spine (CSD) disorders in asthmatic children J Clin Pediatr Dent 200529(4)287-92
Nasal Breathing
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Nitric
Oxide
PATRICK MCKEOWN MA
ButeykoCliniccom
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
NO concentrations of 50ndash200 parts per billion (ppb) are
transported to the lungs with every nasal inhalation
compared with 10 ppb during oral breathing
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Furthermore autoinhalation of endogenous NO from the
nasal airways has been shown to improve arterial
oxygenation and reduce pulmonary vascular resistance
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Compared with oral breathing inhalation of NO
(endogenous or exogenous) caused an overall significant
blood flow shift from the base of the lung toward the apex
resulting in a more homogeneous blood flow distribution
along the height of the lung
o J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
The biological significance of nasal breathing which
improved peripheral oxygenation by 5ndash15 in healthy
volunteers compared with oral breathing J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
The transition to bipedalism is that it would also result in an
increased susceptibility to some pulmonary infections most
notably tuberculosis
Therefore upper airway NO could have emerged in bipedal
mammals not only to improve gas exchange but also to
provide some protection against infection
J Appl Physiol 108 181ndash188 2010
NITRIC OXIDE
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Hyperventilation
Syndrome
PATRICK MCKEOWN MA
ButeykoCliniccom
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
14 patients presented complaining of nasal congestion
after previous nasal surgery and who appeared to have an
adequate nasal airway with no evidence of nasal valve
collapse were evaluated for HVS
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
All patients had an elevated respiratory rate (gt18
breathsminute) with an upper thoracic breathing
pattern Twelve of the 14 patients complaining of nasal
obstruction had an elevated Nijmegen score indicative of
HVS An average number of 25 procedures had been
performed on each patient
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
Conclusion HVS should be
included in the differential
diagnosis of patients presenting
with nasal congestion particularly after failed nasal surgery
Am J Rhinol 2005 Nov-Dec19(6)607-11
HYPERVENTILATION SYNDROME
