DE102018000995A1 - Arrangement for the quantitative measurement of the elastic deformation of the lateral nasal wall (elastometry) - Google Patents

Abstract

The invention relates to an arrangement for the quantitative determination of the elastic deflection of the lateral nasal wall by the influence of nasal breathing, wherein the deflection can be determined contactless or low-contact electromechanical by strain gauges, by measuring the inductance change or by optical methods (time of flight or brightness measurement) , The signals obtained are electronically related to the nasal airflow parameters differential pressure and volumetric flow or derivatives of these quantities.

Description

The invention relates to an arrangement for determining the elastic deflection of the lateral nasal wall by the influence of nasal breathing

From a medical point of view, there is a need for diagnostic objectification of respiratory induced deformation of the lateral nasal wall in the context of preoperative diagnostics and prior to the prescription of aids to dilate the nasal entrance

State of the art

The nasal breathing energy is determined primarily by the width of the nasal flow channel. The basis for this is the law of Hagen-Poiseuille, according to which the resistance of a body through which it flows depends on the 4.potency of the radius. This also applies to a large extent, if it is not an ideal pipe but an irregular flow body with a calculated flow cross-section. This means that the narrowest point of a flow body has a decisive influence on the flow resistance. It is known that the nasal entrance is the narrowest part of the entire upper airways and therefore has a decisive influence on the total resistance of the respiratory system.

In the dynamic analysis of the nasal air flow, it is crucial that the nose does not present a rigid flow resistance, but a flow channel which can narrow under the influence of the generated flow, which is also referred to as a "starling-resistor". This Bernouilli effect can be generated by intensified inhalation ("pulling up") in a physiological manner to remove unwanted nasal mucus to the rear, but it also occurs in some people with slightly recessed breathing through physical exertion, thus leading to a significant physical Impairment. This effect is particularly important when the flow channel is already anatomically narrowed, the air flow at the entrance is therefore particularly accelerated and then the nose is finally completely blocked by the Bernouilli effect which is thus triggered more rapidly.

Anatomically, the lateral nasal wall consists of centrally located relatively thin cartilages which are covered with skin which carries hair on the inside. These cartilages are the lateral portion of the alar cartilage (crus lateral cartilaginis alaris majoris) and the lateral cartilage (cartilago lateralis), also called triangular cartilage. On the outside advertise parts of the facial muscles. Together with the connective tissue structures and the covering skin layers, these form the functional structure of the nasal valve, which older authors differentiate into an "inner" and "outer" nasal valve. This subdivision is misleading: the nasal valve is a functional unit that can be pulled outward by muscle activity and can be moved passively inward and, to a lesser extent, on exhalation through the action of the nasal airflow during inhalation.

Various methods are known for directly or indirectly measuring nasal respiratory resistance. These include computed tomography, magnetic resonance imaging, volumetry, acoustic rhinometry, the Odiosoft method and rhinostereometry, all of which conclude its functionality from the shape of the nasal cannula (Malm, L., Allergy 1997 ; 52 : 19-23). None of these methods considers the effect of nasal deformation under the influence of respiration. Also, the morphological representation of the nasal airflow by Computational Fluid Dynamics can not make any statement about this peculiarity of the nasal respiratory function at this time. A summarized up-to-date account of the currently used functional tests of the nasal respiratory flow can be found in the commented report of an expert conference (Vogt K, Bachmann-Harildstad G, Garyuk O, Lintermann A, Nechyporenko A, Peters F, Wernecke KD: The Riga agreement of the international consensus conference on nasal airway function tests 2018 , in print). There is also indicated that there are only 2 methods for directly determining the energetics of nasal breathing. These are the rhinomanometry and the measurement of the Peak Nasal Inspiratory Volume. (PNIF). The latter method is unsuitable for determining the influence of elasticity, because it basically measures under conditions which result in the suction of the nostrils. Rhinomanometry is the only measurement method that correctly measures and interrelates the two parameters volume (flux) V and narino-chanal differential pressure ΔP. Since the introduction of 4-phase rhinomanometry (Vogt K, Jalowayski AA, Althaus W et al., 4-Phase Rhinomanometry (4PR) - Basics and Practice 2010. Rhinology Suppl. 21, 2010: 1-50), which is now available as the standard method for the calculation of clinically relevant parameters of nasal respiration, the influence of the elastic deformation of the nostrils has become graphically representable. However, a quantitative determination of this influence is not yet possible. A relatively rough estimate is possible from the mapping of loops in the inspiratory part of the rhinomanometric graph ( 1 ). The loops are caused by a phase shift between the flow and pressure curves, which results from the fact that during the increase in nasal breathing in inspiration by the increased flow, the Bernouilli effect sets in, which leads to a decreased flux in the second, descending inspiratory respiratory phase.

The so-called "flap phenomena" described in practice are of considerable clinical importance to the person concerned, which is why a large number of treatment methods for alleviating such effects are proposed. These range from prosthetic measures, so-called dilators such as "Airmax" (USD 540,462) on expansive patches for athletes or for nocturnal use to complex operational measures. These may consist in the implantation of expanding implants of various alloplastic materials such as titanium or silicone or take place in operative steps within the scope of extensive rhinoplasty or septorhinoplasty, which are performed in a considerable number of countries worldwide and among the most common operations in the area of the nose and throat. Otolaryngology belong. The indication for such operations is generally based exclusively on the visual findings, but there is a clear tendency for preoperative evaluation of nasal breathing by rhinomanometry, especially after the introduction of 4-phase rhinomanometry as a method with a significantly improved diagnostic result due to improved diagnostic parameters , In most textbooks or surgical teachings, the preoperative diagnostics are not taken into account, the considerable number of failures in such operations is well known, but hardly published. The improvement of the functional diagnosis of the nose is therefore a medically important problem.

Further functional diagnostic procedures are concerned with swelling changes of the nasal mucosa in the context of inflammation or allergic reactions. This includes optical rhinometry ( DE 10215212 . DE 10257371 ), with which for these pathophysiological processes quantitative statements are possible. Optical rhinometry makes no statements about physical changes in the nasal airflow.

task

The object of the invention is to describe a measuring arrangement with which the movements of the lateral nasal wall occurring during nasal breathing can be determined quantitatively and the measured values obtained are to be related to other functional diagnostic parameters, in particular to the volume flow of nasal respiration measured during rhinomanometry of the differential pressure necessary for its generation. By suitable multi-channel optical representation of the signals obtained and their computational processing, the quantitative relationship between the movement of the lateral nasal wall and its effect on the nasal breathing energy should be determined numerically. The applied measuring means should not touch the lateral nasal wall or limit its mobility.

Solution of the task

The object is solved by the features of claim 1. Expedient embodiments emerge from the subclaims 2 to 6 and consists in generating an electrical signal corresponding to the respiratory lateral deflection of the lateral nasal wall. The measurement of the deflection of the lateral nasal wall can be done either electromechanical way according to claim 2, by inductive means according to claim 3 or optically according to claim 4 and 5. The generated analog or digital electrical signals may be related to measured rhinomanometric signals. The arrangement according to claim 2 is that the lateral nose wall of resilient elements 5 is touched with minimal force, which follow their deflection without exerting a compression effect. The bending occurring at the other end of the elastic elements is determined by means of strain gauges 4 measured and the appropriately prepared electrical signal used diagnostically ( 2 ). The solution according to claim 3 is that at the deepest retraction of the lateral nasal wall, a ferromagnetic element 11 is temporarily glued, whose distance from an induction sensor 12 is determined. The signal obtained is processed in the same way as in claim 2. The solution according to claim 4 consists in the optical distance measurement of the distance between the lateral nasal wall and a suitable optical sensor, wherein both the direct or the indirect measurement of the TOF (Time Of Flight) can be considered. The signal obtained is processed as above. The solution according to claim 5 is, under the nose entrance a micro camera with light source 16 . 17 which is directed to the visible nostril and does not obstruct the nasal airflow. The camera can also be replaced by an endoscope. The signal emitted by the light source and directed to the nostril is detected spectroscopically. The intensity of the reflected light increases as the cross section of the nostril becomes smaller. The patented solution is further to set the signal generated according to claims 1-6 in relation to the rhinomanometric signals for flow and differential pressure. Occurring shifts between the elastometric and flow-specific signals, conclusions can be drawn about the effect of the Bernouilli effect on the air flow and the resulting deformation of the nasal wall.

• 1: 4-Phasen-Rhinomanometrie in Standarddarstellung (1) mit inspiratorischer Schleife (2)
• 2 zeigt eine Anordnung nach Anspruch 2, worin 3 die Grenze zwischen beweglichem und unbeweglichem Teil der seitlichen Nasenwand darstellt, 4 den auf ein anliegendes federndes Element 5 geklebten Dehnungsmessstreifen, wobei das anliegende federnden Element von einem Trägerteil 6 mit Doppelgelenk gehalten wird. Das Trägerteil 6 ist an einem Stirnband oder Klebestreifen 7 an der Stirn fixiert, von welchem auch die Spannungsversorgungs- und Signalleitung 8 getragen wird.
• 3 zeigt eine Anordnung nach Anspruch 3 mit der rechten Nasenhaupthöhle 9 und der linken Nasenhaupthöhle 10, mit welcher die Bewegungen eines ferromagnetischen Elementes 11 durch einen Induktionssensor 12 gemessen und über die Spannungsversorgungs- und Signalleitungen 13 abgeleitet werden. Das ferromagnetische Element 11 ist im Beispiel während der Messung auf den linken Nasenflügel aufgeklebt.
• 4 zeigt eine Anordnung nach Anspruch 4 mit den Nasenhaupthöhlen 9 und 10 und einer ringförmigen Lichtquelle 14, die beispielsweise einem Endoskop oder ringförmig angeordneten Leuchtdioden entsprechen kann sowie einem lichtaufnehmenden Element 15, welches wie typisch in einem Endoskop aus Lichtfasern besteht, welche das Licht zu einer an diesem Endoskop angekoppelten Kamera führen. Das optische Signal kann auch mit einer Mikrokamera erzeugt werden, die am Ende des Lichtträgers objektnah angebracht ist. Das optische Signal wird in ein elektrisches Signal umgewandelt.
• 5A und 5 B zeigen die rechte und linke Nasenhaupthöhle 9 und 10, wobei die linke Nasenhaupthöhle 10 offen ist und die rechte Nasenhaupthöhle 9 durch die Wirkung des Bernouilli-Klappeneffektes nach innen eingezogen wird. Von der offenen linken Nasenhaupthöhle 10-wird das von dem Licht ausendenden Element 16 (zum Beispiel von einem Leuchtdiodenring) ausgesendete Licht weniger reflektiert als von der kontrahierten rechten Nasenhaupthöhle 10 Das Lichtsignal wird mit Hilfe einer Mikrokamera 17 gemessen und als elektrisches Signal über die Spannungsversorgungs- und Signalleitung 18 abgeleitet.

The solution should be based on the 1 - 4 be explained:

• 1 : 4-phase rhinomanometry in standard representation ( 1 ) with inspiratory loop ( 2 )
• 2 shows an arrangement according to claim 2, wherein 3 represents the boundary between the movable and immovable part of the lateral nose wall, the 4 on an adjacent resilient element 5 glued strain gauges, wherein the adjacent resilient member of a support member 6 is held with double joint. The carrier part 6 is on a headband or tape 7 fixed on the forehead, from which also the voltage supply and signal line 8th will be carried.
• 3 shows an arrangement according to claim 3 with the right nasal cavity 9 and the left nasal cavity 10 with which the movements of a ferromagnetic element 11 through an induction sensor 12 measured and across the power and signal lines 13 be derived. The ferromagnetic element 11 is glued in the example during the measurement on the left nostril.
• 4 shows an arrangement according to claim 4 with the Nasenhaupthöhlen 9 and 10 and an annular light source 14 , which may correspond, for example, an endoscope or annularly arranged light-emitting diodes and a light-receiving element 15 which, as is typical in an endoscope, consists of optical fibers which guide the light to a camera coupled to this endoscope. The optical signal can also be generated with a micro-camera, which is attached to the end of the light carrier close to the object. The optical signal is converted into an electrical signal.
• 5A and 5 B show the right and left nasal cavities 9 and 10 , where the left nasal cavity 10 is open and the right nasal cavity 9 is drawn inwards by the effect of the Bernouilli flap effect. From the left open nasal cavity 10 becomes the element emitting the light 16 (For example, from a light-emitting diode ring) emitted light less reflected than from the contracted right nasal cavity 10 The light signal is using a microcamera 17 measured and as an electrical signal via the voltage supply and signal line 18 derived.

LIST OF REFERENCE NUMBERS

1

Standard Diagram Rhinomanometry 2017

2

Hysteresis loop as elastic sequence

3

Border between rigid and elastic nose wall

4

Strain gauges

5

Feathering fitting element

6

Device carrier with double joint

7

Headband or bandaid

8th

Power supply and signal line

9

Right nasal cavity

10

Left nasal cavity

11

Ferromagnetic element

12

inductive sensor

13

Power supply and signal line

14

Optical sensor - Annular light source

15

Optical sensor - light-receiving element

16

light source

17

micro camera

18

Power supply and signal line

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 10215212 [0008]
• DE 10257371 [0008]

Claims (6)

Device for the quantitative measurement of the elastic deformation (elastometry) of the lateral nasal wall, characterized in that the movement of the lateral nasal wall triggered by the nasal air flow is determined quantitatively without contact or with such minimal contact, which does not influence this movement and is characterized by this measurement electrical signal is generated. Device after Claim 1 , characterized in that at the movable part of the lateral nose wall, a resilient element (5) is applied with minimal pressure, whose deflection measured by strain gauges (4) and thus generates an electrical signal and further that this element during the measurement in a suitable manner a headband or bandage (7) is immovably held on the forehead or the nasal bone ( 2 ) Device after Claim 1 , characterized in that the deflection of the lateral nasal wall is measured by mounting on it during measurement a ferromagnetic element (11) whose distance to an appropriately positioned induction sensor (12) is measured thereby generating an electrical signal ( 3 ) Device after Claim 1 , characterized in that the deflection of the lateral nasal wall is measured by fitting, at a suitable distance from the nasal wall, an optical sensor (14) (15) which determines the distance directly or indirectly by measuring the time of flight (TOF) and generates an electrical signal ( 4 ). Device after Claim 1 , characterized in that a microcamera (17), an endoscope or other photoconductive element is mounted under the nostril so that the nasal air flow is unaffected and that this element measures the optical changes which occur at the nostril due to the influence of the nasal airway Nasal breathing, namely the reduction or enlargement of the nostril, and that with it an electrical signal is generated ( 5 A and B) Method according to Claim 1 to 5 , characterized in that the electrical signals generated in these measuring methods are simultaneously related to the parameters generated by rhinomanometry differential pressure ΔP and volume flow (flux) V or derivatives of these parameters by means of an evaluation and relating to the diagnostic statement related software and that thereby the Reaction rate and deflectability of the lateral nasal wall in time dependence on differential pressure and flux is determined.

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