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Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

¹ Dept of Physiology and Pharmacology, Karolinska Institutet, ² Dept of Anesthesiology and Intensive Care, Karolinska Hospital and ³ Dept of Speech Music and Hearing, Royal Institute of Technology, Stockholm, Sweden. ⁴ #Dept of Respiratory Medicine, University Federico II, Naples, Italy

CORRESPONDENCE: J.O. Lundberg, Dept of Physiology and Pharmacology, 171 77 Karolinska Institutet, Stockholm, Sweden. Fax: 46 8332278. E-mail: jon.lundberg@fyfa.ki.se

Keywords: asthma, exhaled nitric oxide, nasal, rhinitis, sinusitis

Received: February 17, 2003
Accepted April 24, 2003

This study was supported by a grant from the Swedish Heart-Lung Foundation, the Swedish Research Council and by a grant from University Federico II "Progetto scambi internazionali".

Nasal nitric oxide (NO) levels increase greatly during humming compared to silent exhalation. In this study, the physiological and anatomical factors that regulate NO release during humming have been characterised in 10 healthy subjects and in a model of the sinus and the nose.

Single-breath humming caused a large initial peak in nasal NO output, followed by a progressive decline. The NO peak decreased in a step-wise manner during repeated consecutive humming manoeuvres but recovered completely after a silent period of 3 min. Topical nasal application of an NO synthase inhibitor reduced nasal NO by >50% but had no effect on the increase evoked by humming. Silently exhaled nasal NO measured immediately after repeated humming manoeuvres was between 5–50% lower than basal silent NO exhalation, suggesting variable continuous contribution from the sinuses to nasal NO. Among the factors known to influence normal sinus ventilation, ostium size was the most critical during humming, but humming frequency was also of importance.

In conclusion, humming results in a large increase in nasal nitric oxide, which is caused by a rapid gas exchange in the paranasal sinuses. Combined nasal nitric oxide measurement with and without humming could be of use to estimate sinus ventilation and to better separate nasal mucosal nitric oxide output from sinus nitric oxide in health and disease.

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