Medicine Section - Rhinomanometry and Acoustic and Optical Rhinometry

IMPORTANT REMINDER

Regence Medical Policies are developed to provide guidance for members and providers regarding coverage in accordance with contract terms. Benefit determinations are based in all cases on the applicable contract language. To the extent there may be any conflict between the Medical Policy and contract language, the contract language takes precedence.

PLEASE NOTE: Contracts exclude from coverage, among other things, services or procedures that are considered investigational or cosmetic. Providers may bill members for services or procedures that are considered investigational or cosmetic. Providers are encouraged to inform members before rendering such services that the members are likely to be financially responsible for the cost of these services.

Description
Rhinomanometry is a test of nasal function that measures air pressure and the rate of airflow in the nasal airway during respiration. These findings are used to calculate nasal airway resistance. Rhinomanometry is intended to be an objective quantification of nasal airway patency.

Acoustic rhinometry is a technique intended for assessment of the geometry of the nasal cavity and nasopharynx and for evaluating nasal obstruction. The technique is based on an analysis of sound waves reflected from the nasal cavities.

Optical rhinometry utilizes an emitter and a detector placed at opposite sides of the nose and can detect relative changes in nasal congestion by the change in transmitted light.  The technique is based on the absorption of red/near-infrared light by hemoglobin and the endonasal swelling-associated increase in local blood volume.

The techniques are proposed for use in allergy testing, comparing decongestive action of antihistamines and corticosteroids, for evaluation of obstructive sleep apnea, and for assessment of the patient prior to nasal surgery.

Ten models of rhinomanometers have received marketing clearance by the U.S. Food and Drug Administration (FDA) 510(k) process.  Optical rhinometry is a new technique that is being developed in Europe, but no devices have received clearance for marketing in the U.S.

Policy/Criteria

Acoustic and optical rhinometry and rhinomanometry are considered investigational.

Scientific Background

This policy was originally based on a BlueCross BlueShield Association Technology Evaluation Center (TEC) assessment (2), which reached the following conclusions:

• The available evidence does not conclusively demonstrate the ability of rhinomanometry or acoustic rhinometry to improve health outcomes in the assessment of nasal airway patency. Specifically, no data have supported the use of these techniques as methods to differentiate causes of obstruction.
• Reports on the use of rhinomanometry or acoustic rhinometry to select patients for surgery have not fully studied the predictive value of these tests.
• Finally, the benefit of these tests as adjuncts to or replacements of other technologies has not been adequately demonstrated in the literature.

More recent published literature indicated that rhinomanometry, acoustic rhinometry and optical rhinometry were investigated for the following purposes (3-13, 17-20):

• As objective measurements of treatment efficacy in research studies;
• In the diagnosis of allergic rhinitis;
• In the surgical evaluation of nasal obstruction;
• To assess tolerance to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea.

No studies provided a detailed analysis of how these three diagnostic studies would be used in the clinical management of the patient, whether they were more clinically relevant or accurate compared to patient self-assessment and whether they would improve health outcomes compared to standard approaches.  While patient self-assessment is difficult in infants and small children (14,15), there were insufficient data to permit scientific conclusions in this population of patients.

References

1. Blue Cross BlueShield Association Medical Policy Reference Manual, Policy No. 2.01.08
2. 1987 TEC Assessment: Rhinomanometry
3. Schumacher MJ. Nasal congestion and airway obstruction: the validity of available objective and subjective measures. Curr Allergy Asthma Rep 2002;2:245-51
4. Larivee Y, Leon Z, Salas-Prato M et al. Evaluation of the nasal response to histamine provocation with acoustic rhinometry. J Otolaryngol 2001;30:319-23
5. Wilson AM, Sims EJ, Orr LC et al. Effects of topical corticosteroid and combined mediator blockade on domiciliary and laboratory measurement of nasal function in seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2001;87:344-49
6. Ellegard EK, Hellgren M, Karlsson NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol 2001;26:394-400
7. Rhee CS, Kim DY, Won TB et al. Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate. Laryngoscope 2001;111:153-58
8. Suzina AH, Hamzah M, Samsudin AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol 2003; 117(8):609-13
9. Numminen J, Dastidar P, Heinonen T et al. Reliability of acoustic rhinometry. Respir Med 2003; 97(4):421-7
10. Mamikoglu B, Houser SM, Corey JP. An interpretation method for objective assessment of nasal congestion with acoustic rhinometry. Laryngoscope 2002; 112(5):926-9
11. Ceroni Compadretti G, Tasca I, Alessandri-Bonetti G et al. Acoustic rhinometric measurements in children undergoing rapid maxillary expansion. Int J Pediatr Otorhinolaryngol 2005;70(1):27-34
12. Ciprandi G, Marseglia GL, Klersy C et al. Relationships between allergic inflammation and nasal airflow in children with persistent allergic rhinitis due to mite sensitization. Allergy 2005; 60(7):957-60
13. Nathan RA, Eccles R, Howarth PH et al. Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2005;115(3 pt 2):S442-59
14. Priftis KN, Drigopoulos K, Sakalidou A et al. Subjective and objective nasal obstruction assessment in children with chronic rhinitis. Int J Pediatr Otorhinolaryngol 2005;70(3):501-5
15. Djupesland P, Pedersen OF. Acoustic rhinometry in infants and children. Rhinol Suppl 2000;16:52-58
16. Cakmak O, Coskun M, Celik H et al. Value of acoustic rhinometry for measuring nasal valve area. Laryngoscope 2003; 113(2):295-302
17. Corey JP. Acoustic rhinometry: should we be using it? Curr Opin Otolaryngol Head Neck Surg 2006; 14(1):29-34
18. Uzzaman A, Metcalfe DD, Komarow HD. Acoustic rhinometry in the practice of allergy. Ann Allergy Asthma Immunol 2006; 97(6):745-51
19. Morris LG, Setlur J, Burschtin OE et al. Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study. Am J Rhinol 2006; 20(2):133-7
20. Wustenberg EG, Zahnert T, Huttenbrink KB et al.  Comparison of optical rhinometry and active anterior Rhinomanometry using nasal provocation testing.  Arch Otolaryngol Head Neck Surg  2007;133(4):344-9

Cross References
None

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