Download PDF
Facial Plast Surg 2024; 40(03): 310-313
DOI: 10.1055/a-2236-4581
Original Article

Peak Nasal Inspiratory Flow (PNIF) for Nasal Breathing Evaluation

Rui Xavier 
1   Hospital Luz Arrabida, Porto, Portugal
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or dimensions provide valuable data but are time-consuming and require expensive equipment and trained technicians, thus making these methods less practical for clinical practice. Peak nasal inspiratory flow (PNIF) measurement is fast, unexpensive, noninvasive, and able to provide an objective evaluation of nasal airflow in real-time. Unilateral PNIF measurements allow separated evaluation of each side of the nasal airway and may prove particularly useful when clinical assessment detects significant asymmetry between both nasal cavities.

PNIF measurements are most useful for assessing changes in nasal airflow achieved by any form of therapy, including surgical treatment of the nasal airway. These measurements generally correlate with other objective methods for nasal airway evaluation, but not unequivocally with patient-reported evaluation of nasal breathing. Nevertheless, as low PNIF values prevent the sensation of a suitable nasal breathing, PNIF measurement may also prove useful to optimize the decision of how to best address patients with complaints of nasal airway obstruction.

Keywords

peak nasal inspiratory flow - PNIF - nasal airway evaluation


Publication History

Accepted Manuscript online:
29 December 2023

Article published online:
08 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Fuller JC, Bernstein CH, Levesque PA, Lindsay RW. Peak nasal inspiratory flow as an objective measure of nasal obstruction and functional septorhinoplasty outcomes. JAMA Facial Plast Surg 2018; 20 (02) 175-176
    CrossrefPubMedSearch in Google Scholar
  • 2 Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy 2016; 71 (02) 162-174
    CrossrefPubMedSearch in Google Scholar
  • 3 Fuller JC, Gadkaree SK, Levesque PA, Lindsay RW. Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty. Laryngoscope 2019; 129 (03) 594-601
    CrossrefPubMedSearch in Google Scholar
  • 4 Ottaviano G, Lund VJ, Nardello E. et al. Comparison between unilateral PNIF and rhinomanometry in healthy and obstructed noses. Rhinology 2014; 52 (01) 25-30
    CrossrefPubMedSearch in Google Scholar
  • 5 Cho SI, Hauser R, Christiani DC. Reproducibility of nasal peak inspiratory flow among healthy adults: assessment of epidemiologic utility. Chest 1997; 112 (06) 1547-1553
    CrossrefPubMedSearch in Google Scholar
  • 6 Harar RP, Kalan A, Kenyon GS. Assessing the reproducibility of nasal spirometry parameters in the measurement of nasal patency. Rhinology 2001; 39 (04) 211-214
    PubMedSearch in Google Scholar
  • 7 Dufour X, Gohler C, Delagranda A, Fontanel JP, Klossek JM. [Peak nasal inspiratory flow: learning curve for the measurement method and reproducibility]. Ann Otolaryngol Chir Cervicofac 2007; 124 (03) 115-119
    PubMedSearch in Google Scholar
  • 8 Starling-Schwanz R, Peake HL, Salome CM. et al. Repeatability of peak nasal inspiratory flow measurements and utility for assessing the severity of rhinitis. Allergy 2005; 60 (06) 795-800
    CrossrefPubMedSearch in Google Scholar
  • 9 Kaura A, Virk JS, Joseph J, Rennie C, Singh Randhawa P, Andrews PJ. The role of unilateral nasal inspiratory peak flow in nasal obstruction-a study of 70 patients undergoing septorhinoplasty surgery. Clin Otolaryngol 2019; 44 (03) 427-430
    CrossrefPubMedSearch in Google Scholar
  • 10 Marais J, Murray JA, Marshall I, Douglas N, Martin S. Minimal cross-sectional areas, nasal peak flow and patients' satisfaction in septoplasty and inferior turbinectomy. Rhinology 1994; 32 (03) 145-147
    PubMedSearch in Google Scholar
  • 11 Larsen K, Oxhøj H, Grøntved A, Kristensen S. Peak flow nasal patency indices in patients operated for nasal obstruction. Eur Arch Otorhinolaryngol 1990; 248 (01) 21-24
    CrossrefPubMedSearch in Google Scholar
  • 12 Cook JA, McCombe AW, Jones AS. Laser treatment of rhinitis–1 year follow-up. Clin Otolaryngol Allied Sci 1993; 18 (03) 209-211
    CrossrefPubMedSearch in Google Scholar
  • 13 Xavier R. Does rhinoplasty improve nasal breathing?. Facial Plast Surg 2010; 26 (04) 328-332
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Lund VJ, Scadding GK. Objective assessment of endoscopic sinus surgery in the management of chronic rhinosinusitis: an update. J Laryngol Otol 1994; 108 (09) 749-753
    CrossrefPubMedSearch in Google Scholar
  • 15 Kjaergaard T, Cvancarova M, Steinsvåg SK. Relation of nasal air flow to nasal cavity dimensions. Arch Otolaryngol Head Neck Surg 2009; 135 (06) 565-570
    CrossrefPubMedSearch in Google Scholar
  • 16 Taylor G, Macneil AR, Freed DL. Assessing degree of nasal patency by measuring peak expiratory flow rate through the nose. J Allergy Clin Immunol 1973; 52 (04) 193-198
    CrossrefPubMedSearch in Google Scholar
  • 17 Holmström M, Scadding GK, Lund VJ, Darby YC. Assessment of nasal obstruction. A comparison between rhinomanometry and nasal inspiratory peak flow. Rhinology 1990; 28 (03) 191-196
    PubMedSearch in Google Scholar
  • 18 Jones AS, Viani L, Phillips D, Charters P. The objective assessment of nasal patency. Clin Otolaryngol Allied Sci 1991; 16 (02) 206-211
    CrossrefPubMedSearch in Google Scholar
  • 19 Bermüller C, Kirsche H, Rettinger G, Riechelmann H. Diagnostic accuracy of peak nasal inspiratory flow and rhinomanometry in functional rhinosurgery. Laryngoscope 2008; 118 (04) 605-610
    CrossrefPubMedSearch in Google Scholar
  • 20 Ganslmayer M, Spertini F, Rahm F, Terrien MH, Mosimann B, Leimgruber A. Evaluation of acoustic rhinometry in a nasal provocation test with allergen. Allergy 1999; 54 (09) 974-979
    CrossrefPubMedSearch in Google Scholar
  • 21 Klossek JM, Lebreton JP, Delagranda A, Dufour X. PNIF measurement in a healthy French population. A prospective study about 234 patients. Rhinology 2009; 47 (04) 389-392
    PubMedSearch in Google Scholar
  • 22 Ottaviano G, Scadding GK, Coles S, Lund VJ. Peak nasal inspiratory flow; normal range in adult population. Rhinology 2006; 44 (01) 32-35
    PubMedSearch in Google Scholar
  • 23 Ottaviano G, Scadding GK, Scarpa B, Accordi D, Staffieri A, Lund VJ. Unilateral peak nasal inspiratory flow, normal values in adult population. Rhinology 2012; 50 (04) 386-392
    CrossrefPubMedSearch in Google Scholar
  • 24 Ottaviano G, Lund VJ, Coles S, Staffieri A, Scadding GK. Does peak nasal inspiratory flow relate to peak expiratory flow?. Rhinology 2008; 46 (03) 200-203
    PubMedSearch in Google Scholar
  • 25 Timperley D, Srubisky A, Stow N, Marcells GN, Harvey RJ. Minimal clinically important differences in nasal peak inspiratory flow. Rhinology 2011; 49 (01) 37-40
    CrossrefPubMedSearch in Google Scholar
  • 26 Weitzman RE, Feng AL, Justicz N, Gadkaree SK, Lindsay RW. Unilateral nasal obstruction causes symptom severity scores similar to bilateral nasal obstruction. Facial Plast Surg 2020; 36 (04) 487-492
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 van Spronsen E, Ingels KJ, Jansen AH, Graamans K, Fokkens WJ. Evidence-based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system. Allergy 2008; 63 (07) 820-833
    CrossrefPubMedSearch in Google Scholar
  • 28 Fairley JW, Durham LH, Ell SR. Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate. Clin Otolaryngol Allied Sci 1993; 18 (01) 19-22
    CrossrefPubMedSearch in Google Scholar
  • 29 Jones AS, Willatt DJ, Durham LM. Nasal airflow: resistance and sensation. J Laryngol Otol 1989; 103 (10) 909-911
    CrossrefPubMedSearch in Google Scholar
  • 30 Yepes-Nuñez JJ, Bartra J, Muñoz-Cano R. et al. Assessment of nasal obstruction: correlation between subjective and objective techniques. Allergol Immunopathol (Madr) 2013; 41 (06) 397-401
    CrossrefPubMedSearch in Google Scholar
  • 31 Pendolino AL, Nardello E, Lund VJ. et al. Comparison between unilateral PNIF and rhinomanometry in the evaluation of nasal cycle. Rhinology 2018; 56 (02) 122-126
    CrossrefPubMedSearch in Google Scholar
  • 32 Wilson AM, Dempsey OJ, Sims EJ, Lipworth BJ. Subjective and objective markers of treatment response in patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2000; 85 (02) 111-114
    CrossrefPubMedSearch in Google Scholar
  • 33 Clarke RW, Jones AS. The limitations of peak nasal flow measurement. Clin Otolaryngol Allied Sci 1994; 19 (06) 502-504
    CrossrefPubMedSearch in Google Scholar
  • 34 André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009; 34 (06) 518-525
    CrossrefPubMedSearch in Google Scholar
  • 35 Barnes ML, White PS, Gardiner Q. Re: Correlation between subjective and objective evaluation of the nasal airway. Clin Otolaryngol 2010; 35 (02) 152-153 , author reply 153
    CrossrefPubMedSearch in Google Scholar
  • 36 Zhao K, Blacker K, Luo Y, Bryant B, Jiang J. Perceiving nasal patency through mucosal cooling rather than air temperature or nasal resistance. PLoS One 2011; 6 (10) e24618
    CrossrefPubMedSearch in Google Scholar
  • 37 Mohan S, Fuller JC, Ford SF, Lindsay RW. Diagnostic and therapeutic management of nasal airway obstruction - advances in diagnosis and treatment. JAMA Facial Plast Surg 2018; 20 (05) 409-418
    CrossrefPubMedSearch in Google Scholar
  • 38 Xavier R, Azeredo-Lopes S, Menger DJ, de Carvalho HC, Spratley J. Objective measurement and patient-reported evaluation of the nasal airway: is correlation dependent on symptoms or on nasal airflow?. Clin Otolaryngol 2021; 46 (04) 744-751
    CrossrefPubMedSearch in Google Scholar