In the Journals

Review finds nasal dilators might be alternative to surgery

Researchers found limited evidence showing that nasal dilator strips and nasal clips relieve obstruction in the nasal valve and could be potential alternatives to surgical intervention, according to a systematic review published recently in JAMA Facial Plastic Surgery.

Researchers conducted an internet search via Google, Amazon.com and PubMed between April 1, 2013, and Dec. 31, 2015, to create a database of 33 available over-the-counter nasal dilators. Discontinued or unavailable products were not included.

Objective measures, including measured airflow, the cross-sectional area of the nasal valve and changes resistance, were used to determine efficacy of the products.

Mechanical action of the dilators determined four categories of classification: External nasal dilator strips, nasal stents, nasal clips and septal stimulators. Retail prices ranged from 33 cents for daily disposable devices to $69 for lifetime reusable devices.

A PubMed literature search found 10 articles deemed as relevant literature reviews for five of the products. A review article found a sixth relevant product. Devices scientifically evaluated for efficacy of nasal dilation were external nasal dilator strips AirPlus nasal strips (AirPlus Denmark A/S), Breathe Right nasal strips (GlaxoSmithKline) and Clear Passage nasal strips (Clear Passage); nasal stents Max-Air Nose Cones (Sanostec Corp.); and nasal clips Airmax nasal dilator (Coopon Box Pty Ltd.) and the NoZovent nasal Dilator (Pharmacure Health Care Intl AB).

“Nasal obstruction can be treated through both surgical and medical approaches,” the researchers wrote. “Patients want a treatment that is most convenient and exposes them to the least amount of risk. … When patients come to a specialist or primary care physician with a chief symptom of airway obstruction, examination is performed. In general, patients are first offered pharmacologic therapy and then surgery, should pharmacologic therapy fail. Dilators are often overlooked as a treatment modality that may be explored before surgical intervention.”

“[Nasal dilator] devices for which studies exist have demonstrated ability to dilate the nasal valve and reduce resistance to airflow,” the researchers concluded. “However these studies are limited to only a few devices. Of these devices, external nasal dilators and nasal clips are best studied and appear to be potential alternatives to surgical intervention. Further studies should be performed to evaluate the many different types of mechanical nasal dilators.”

In an accompanying commentary, Julia S. Kimbell, PhD, and Denis O. Frank-Ito, PhD, stressed that these devices are designed for temporary treatment and meant to be used in the short-term.

“Although some nasal dilators are marketed as noninvasive alternative to surgery for use in patients with obstructive sleep apnea and nasal anatomic abnormalities, such as septal deviation, turbinate hypertrophy, and nasal valve compromise, these devices to not currently have the ability to provide long-term patency to individuals with the aforementioned conditions or be seen as truly an alternative option for these conditions,” they wrote. Thus, surgery is still a superior treatment option for nasal airway obstruction.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.

Researchers found limited evidence showing that nasal dilator strips and nasal clips relieve obstruction in the nasal valve and could be potential alternatives to surgical intervention, according to a systematic review published recently in JAMA Facial Plastic Surgery.

Researchers conducted an internet search via Google, Amazon.com and PubMed between April 1, 2013, and Dec. 31, 2015, to create a database of 33 available over-the-counter nasal dilators. Discontinued or unavailable products were not included.

Objective measures, including measured airflow, the cross-sectional area of the nasal valve and changes resistance, were used to determine efficacy of the products.

Mechanical action of the dilators determined four categories of classification: External nasal dilator strips, nasal stents, nasal clips and septal stimulators. Retail prices ranged from 33 cents for daily disposable devices to $69 for lifetime reusable devices.

A PubMed literature search found 10 articles deemed as relevant literature reviews for five of the products. A review article found a sixth relevant product. Devices scientifically evaluated for efficacy of nasal dilation were external nasal dilator strips AirPlus nasal strips (AirPlus Denmark A/S), Breathe Right nasal strips (GlaxoSmithKline) and Clear Passage nasal strips (Clear Passage); nasal stents Max-Air Nose Cones (Sanostec Corp.); and nasal clips Airmax nasal dilator (Coopon Box Pty Ltd.) and the NoZovent nasal Dilator (Pharmacure Health Care Intl AB).

“Nasal obstruction can be treated through both surgical and medical approaches,” the researchers wrote. “Patients want a treatment that is most convenient and exposes them to the least amount of risk. … When patients come to a specialist or primary care physician with a chief symptom of airway obstruction, examination is performed. In general, patients are first offered pharmacologic therapy and then surgery, should pharmacologic therapy fail. Dilators are often overlooked as a treatment modality that may be explored before surgical intervention.”

“[Nasal dilator] devices for which studies exist have demonstrated ability to dilate the nasal valve and reduce resistance to airflow,” the researchers concluded. “However these studies are limited to only a few devices. Of these devices, external nasal dilators and nasal clips are best studied and appear to be potential alternatives to surgical intervention. Further studies should be performed to evaluate the many different types of mechanical nasal dilators.”

In an accompanying commentary, Julia S. Kimbell, PhD, and Denis O. Frank-Ito, PhD, stressed that these devices are designed for temporary treatment and meant to be used in the short-term.

“Although some nasal dilators are marketed as noninvasive alternative to surgery for use in patients with obstructive sleep apnea and nasal anatomic abnormalities, such as septal deviation, turbinate hypertrophy, and nasal valve compromise, these devices to not currently have the ability to provide long-term patency to individuals with the aforementioned conditions or be seen as truly an alternative option for these conditions,” they wrote. Thus, surgery is still a superior treatment option for nasal airway obstruction.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.