Screening Tool to distinguish organic nasal obstruction from functional mouth breathing habit: Study
Establishment of exclusive nasal breathing is now appreciated as the single most important objective in securing adequate craniofacial and airway development in children. Indeed, chronic mouth breathing in growing children is associated with palatal growth restriction, alterations of craniofacial development, altered head posture, sleep disordered breathing, and increased risk for obstructive-sleep apnea later in life. Nasal breathing in adulthood has many advantages: nasal ventilation filters, warms, and humidifies the air; protects against exercise-induced bronchospasm; reduces snoring, improves daytime energy, and self-reported sleep quality; decreases vocal effort and laryngeal dryness; and facilitates anxiety reduction and deep meditation techniques.
Subjective assessment of nasal breathing ability with validated tools such as the Visual Analogue Scale and NOSE score may sometimes be inadequate in chronic mouth breathing subjects who are not consciously aware of problems with nasal breathing.
Furthermore, these tools may prove ineffective in children who cannot accurately articulate difficulties with nasal breathing. Soroush Zaghi and team investigated the efficacy of a simple screening tool to assess the individuals' capacity for comfortable nasal breathing that is based on sealing the lips and mouth with tape while simultaneously assessing whether the subjects can breathe comfortably through the nose for a duration of up to three minutes.
It was a cross-sectional, multi-center cohort study with 663 participants (ages: 3-83 years, 50.5% female). Lips were gently sealed using MicroPore paper tape; timer was used to assess how long the participants were able to breathe comfortably through the nose for up to 180 seconds. Other measures included subjective rating of perceived difficulty with nasal breathing (VAS, 0-100) as well as self-assessed reports of mouth breathing.
There were 9.3% of patients with subjective reports of moderate to severe nasal obstruction (VAS> 50) and 17.2% of patients with predominance of self-reported mouth breathing in this series.
Overall, 93.4% of participants successfully passed the nasal breathing test. Among patients with habitual mouth breathing, 83.5% (91/109) were able to breathe comfortably through the nose when instructed to do so for the entire 3-minute duration tested.
Similarly, there were 67% (40/59) patients with VAS score >50 who could breathe comfortably through the nose for >180 seconds despite subjective reports of moderate to severe nasal obstruction.
Participants unable to breathe exclusively through the nose for 180 seconds had increased likelihood of mouth breathing while awake (p<.0001) as well as increased odds of mouth breathing while asleep (p=0.0003).
This study supports the use of the lip taping nasal breathing test as an effective screening tool in the assessment of mouth breathing and nasal breathing difficulty. Subjects who could not complete the nasal breathing tape test had a four-fold increased likelihood of mouth breathing while awake and three-fold increased likelihood of mouth breathing during sleep. The lip tape test for nasal breathing was found to be a safe, simple, inexpensive, and rationale tool that offers excellent utility in bringing nasal obstruction and/or mouth breathing habit to the forefront of a subject's awareness.
The most interesting finding of this study is that the majority of patients with self-reported mouth breathing and/or subjective reports of moderate to severe nasal breathing difficulty were still physically able to breathe comfortably through the nose for at least three minutes duration when instructed to do so in this study. Therapeutic mouth and lip-taping during the day as well as overnight while asleep has been shown to be helpful in re-educating nasal breathing as well as in improving symptoms of mouth breathing, snoring, and obstructive sleep apnea. Assessment of nasal breathing ability with the lip tape test can help identify patients with organic structural obstructions who would benefit from interventions for nasal obstructions, as well as to distinguish patients with functional deficits who may benefit from re-education of nasal breathing with myofunctional therapy, oro-nasal rehabilitation programs, or simple lip taping to encourage and reinforce nasal breathing as a long-term habit.
Proper breathing, specifically exclusive nasal breathing, is essential to the health and development of children. Children who are unable to breathe well through the nose compensate by breathing more through the mouth. This not only negatively impacts their current health but may also lead to detrimental issues in adulthood. Early detection of improper breathing is therefore vital. Specifically, objectively testing whether a subject can breathe through the nose with the lips and mouth taped for three minutes is a safe and effective screening tool for the assessment of nasal obstruction and mouth breathing habit.
Source: Soroush Zaghi, Cynthia Peterson, Shayan Shamtoob, Brigitte Fung, Daniel Kwok-keung Ng, Triin Jagomagi, Nicole Archambault, Bridget O'Connor, Kathy Winslow, Zahra Peeran, Miche' Lano, Janine Murdock, Sanda Valcu-Pinkerton, Lenore Morrissey. Assessment of Nasal Breathing Using Lip Taping: A Simple and Effective Screening Tool. International Journal of Otorhinolaryngology. Vol. 6, No. 1, 2020, pp. 10-15.