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E. Hizal and O. Cakmak
the incident sound power. In models with constrictions (inserts) of small passage area, the
high-frequency components of the acoustic pulse
generated by AR equipment do not reach the portion of the model beyond the constriction,
because these waves are reected back from the
barrier created by the constriction [6–8, 10, 11].
The effect of a constriction on AR measurements
will also be covered in nasal valve section below.
26.4 Acoustic Rhinometry
Equipment
Acoustic rhinometry is based on the principle of
computation of cross-sectional area–distance
curves from the analysis of the reected sound
waves by the anatomical structures in the nasal
cavity. In other terms, analysis of the sound
waves that are sent into and reected back from
the nasal cavity gives the cross-sectional area at a
given distance.
A picture and a schematic representation of
acoustic rhinometry unit are shown in Figs.26.1
and 26.2, respectively. Acoustic waves that are
produced by a loudspeaker pass through a sound
tube and a nose adapter, which is a detachable
Sound tube
Calibration
probe
Fig. 26.1 Acoustic rhinometry equipment (Rhinoscan
SRE 2000, Interacoustics A/S, Assens, DK)
AR device
Computer
Nose adapters
pipe that establishes a connection between the
AR device and the nose. The sound waves that
cross the nose adapter then reach the nose. As the
sound waves propagate in the nasal cavity, they
are reected by the anatomical structures. A
microphone that is placed within the sound tube
detects the waves that are reected back, and
transforms these into electrical signals. These
signals are then amplied by an amplier and
converted into numeric data by an analoguedigital converter. Numerical data is then analysed
by a computer. Frequency bandwidth of the
sound waves that are sent into the nasal cavity
may contain all audible frequencies between 20
and 20,000Hz. However, low-pass lters exclude
the frequencies over 10,000 Hz since interferences and diffractions increase as the wavelength
of the sound waves travelling in nasal cavity
decrease [3, 6–8].
The changes in cross-sectional area of the airway affect acoustic impedance. Since the nasal
cavity is not a straight pipe and has an irregular
and complex anatomy, acoustic waves show different reection patterns at differing crosssectional areas on their route. Although the
mathematical background of the analysis is very
complex and will be detailed to some extent later
in this chapter, computerized calculations basically give two parameters for a given cross section: Comparison of the amplitudes of the sent
and reected sound waves gives cross-sectional
areas, while the time difference between the sent
and reected sound waves gives the distance of a
given cross-sectional area to the reference point.
These data are then combined and a distance–
area curve is obtained. The areas here dene the
cross-sectional areas that are vertical to the
acoustic pathway, i.e. the way that acoustic waves
follow in the nasal cavity. Cross-sectional area of
a given section is plotted on vertical axis, while
distance of that section to the reference point is
plotted on horizontal axis of the graph. In order to
evaluate the nasal valve region better, vertical
axis can be plotted in logarithmic scale.
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Fig. 26.2 Schematic
representation of an
acoustic rhinometry
circuit
NOSE
SOUND TUBE
LOUDSPEAKER COMPUTER
NOSE ADAPTER
AMPLIFIER LOW-PASS FILTER
MICROPHONE
325
26.5 Test Technique
Classic acoustic rhinometry utilize single impulse
and one microphone (transducer) setup. However,
there are other methods that use two microphones
[12], or devices that use continuous acoustic
stimulation [13]. Although the theory is identical
to that of the single impulse method and the test
technique is similar, a continuous wide-band
noise model allows for almost real-time adjustment of the equipment since a visual output is
generated more than 20 times per second [14].
By means of the modern computer software
the use of acoustic rhinometry is relatively simple. Since external noise, temperature and humidity have potential effects on measurements,
testing room should have standard environmental
conditions. Test should be applied by experienced staff who are aware of the recommendations for reliable testing [15]. Both sides should
be tested separately. Single measurement takes
about a few seconds and whole testing process
ends in a couple of minutes. After the device is
switched on and computer program is opened,
calibration is simply done by following the onscreen instructions that are provided by the man-
Fig. 26.3 Various types of nose adapters are designed to
achieve a better t to shape of the right or left nostril
ufacturer. Calibration should be done every time
the device is opened. The patient should have a
sitting position and position should not be
changed during the tests. Swallowing and breathing should be avoided during the measurements.
Any kind of secretions can narrow the airway and
affect the measurements. Hence, nasal cavity
should be cleaned off from secretions before the
test [16]. Several types of nose adapters with different rim shapes are available (Fig.26.3). A nose
adapter that would best t to the shape of the
patient’s nostril should be chosen and attached to
the probe. To avoid acoustic leak, a medical sealant gel should be applied circumferentially to the
edge of the nose adapter, providing an air secure
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Fig. 26.4 During the measurements, nose probe should
be placed accordingly to prevent acoustic leak. Distortion
of the nose should be avoided
contact between the nose adapter and the nostril
[17]. Nose probe should be placed accordingly to
prevent acoustic leak, but distortion of the nose
or changes in position of the nose probe should
be strictly avoided (Fig.26.4).
Measurements should be repeated for at least
three times to obtain the most correct results. By
this way, erroneous measurements due to acoustic leakage or distortion of the vestibule owing to
incorrect positioning of the probe can be detected
and eliminated.
The operator should be aware of the above
mentioned testing principles and instructions.
Besides the operator errors, complex anatomy of
the nasal cavity, physical limitations of the AR
and factors inherent to the AR algorithms may
inuence the measurements and lead to systematic errors. Nasal cavity has a complex geometry
consisting of cartilaginous and bony framework
covered with erectile tissue and mucosa, including a narrow segment of nasal valve at the anterior part, and sinus ostia more posteriorly. Narrow
segments at anterior parts negatively affect the
measurements of more posterior parts and this
leads to a potential problem since the narrowest
part of the nasal cavity, the nasal valve, is on
anterior part of the cavity. Similarly, ostia of the
paranasal sinuses affect AR measurements, and
cross-sectional areas behind the paranasal sinus
ostia are overestimated. In order to understand
the results of AR measurements, we will try to
take a closer look to the cross-sectional area–distance curve.
E. Hizal and O. Cakmak
26.6 Cross-Sectional Area–
Distance Curve
In order to interpret AR results correctly, it is
essential to know how some anatomical structures in nasal cavity appear on AR area–distance
curves and how these structures’ localizations
and size affect the area–distance curve.
In a typical AR area–distance curve, there is a
minimum on the junction between the nose
adapter and the nostril (Fig.26.5). This minimum
is generally not considered as a “minimum” and
hence not termed as the “rst minimum”, since it
occurs at “0cm” which is the start point of the
nose. rst minimum after the nostril represents
the nasal valve region (Fig.26.5).
There is no clear consensus on interpretation
of AR results, even in healthy humans. Inspection
of the literature reveals that up to 4 local minima
have been commonly observed on the AR area–
distance curves and different terms have been
used to dene these minima. The terms “1st constriction, I-notch, CSA1, MCA, start of isthmus
region, start of valve region, or ostium internum”
have been used for the rst minimum, which was
attributed to the nasal valve; “2nd constriction,
C-notch, CSA2, inferior concha, or piriform
aperture” have been used for the second minimum, which was attributed to the head of the
inferior turbinate, and “CSA3” has been used for
the third minimum, which was usually attributed
to the middle turbinate [3, 10]. However, recent
experimental studies with nasal cavity models
and clinical studies revealed that the second and
third minima on cross-sectional area–distance
curves do not represent an anatomical point, and
hence, most of these terms might be used inappropriately [6–11, 16, 18, 19].
In healthy humans cross-sectional areas measured by different imaging modalities, such as
CT and MRI were compared with AR crosssectional area measurements and the techniques
were found to give comparable results especially
on the anterior part of the nasal cavity [9, 10,
20–25]. Regarding the validation of AR curve
with imaging modalities, a methodological issue
has to be concerned. Areas calculated on AR
measurements are the cross-sectional areas that
12
Distance (cm)
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327
Fig. 26.5 A typical AR
cross-sectional
area–distance curve.
Start point of the nasal
cavity (nostril) is
accepted as “0cm”.
Horizontal axis gives the
distance of a given
cross-sectional area that
is perpendicular to the
acoustic axis to the
nostril. The crosssectional area of that
section is plotted on
vertical axis
5
4
3
)
2
2
Area (cm
1
Sound tube Nose piece
0
-1
-2
-7 -6 -5 -4 -3 -2 -1 012345678910 11
are perpendicular to the sound wave propagation
axis (acoustic axis). In some of the validation
studies, images of the nose were taken perpendicular to the base of the nose, not to the acoustic
axis, and the reference point to be used in distance measurements was either chosen as the
anterior nasal spine [21, 23], or tip of the nose
[25] or even not clearly dened [24]. Studies that
do not care to the sloped anatomy of the nasal
cavity or use different reference points may lead
to signicant errors when interpreting the AR
curve.
In a study on healthy humans, the actual
cross- sectional areas of the nasal cavity together
with the actual locations of the nasal valve, the
head of the inferior turbinate, the head of the
middle turbinate, the openings of the ostia of the
maxillary and frontal sinuses and the choanae
were calculated from computed tomography
sections perpendicular to the curved acoustic
axis of the nasal passage [18]. The ndings were
then compared with the corresponding crosssectional areas measured by AR.Comparison of
the CT- and AR-derived area–distance curves
both before and after decongestion revealed that
the nasal valve is identied by a pronounced
minimum (the rst minimum after the nostril)
on the CT- and AR-derived area–distance
curves. However, neither the head of the inferior
Nostril
Nasal valve
turbinate nor the head of the middle turbinate
could be distinctly identied on the CT area–
distance curves of healthy humans. The same
held true for the AR measurements in both
cadaver cast models and healthy humans [9, 18].
The second and third minima on the AR area–
distance curves did not correspond to the actual
locations of the head of the inferior turbinate
and the head of the middle turbinate determined
from CT, neither before nor after decongestion
[9, 18].
In a study that used cast model of the nasal
cavity of a cadaver, Cakmak etal. demonstrated
that AR was able to detect changes in crosssectional area larger than approximately 0.19cm2
and 0.38cm2, at the head of the inferior turbinate
and the head of the middle turbinate, respectively
[18]. This nding suggests that AR cannot resolve
any change in the cross-sectional area of the nasal
passage at each of these specic anatomic sites
that is smaller than the corresponding limit. In
addition, the ability of AR in measuring abrupt
changes in cross-sectional area is poor, because
of the limited spatial resolution and the long rise
distance of the technique [6, 9].
In summary, with the exception of the rst
minimum after the nostril, which represents the
nasal valve, the subsequent minima on the AR
area–distance curves for both non-decongested
328
a
b
Distance (cm) Distance (cm)
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E. Hizal and O. Cakmak
5
Before decongestion After decongestion
4
N
)
3
2
2
Area (cm
1
0
-1
Fig. 26.6 The cross-sectional area–distance curves of a
healthy human’s nasal cavity as determined by computed
tomography and acoustic rhinometry, before (a) and after
(b) decongestion. Actual locations of the anatomical
structures are determined on computed tomography sections and depicted on the graphs with vertical dashed
lines. The ability of acoustic rhinometry to detect the anatomical structures in nasal cavity can be seen. Acoustic
NV IC MC
012345678
MS
FS
Choana
CT
AR
9101112
and decongested nasal cavities do not correspond
to any anatomic structure in the healthy human
nose (Figs.26.6a, b and 26.7a, b). These minima
are formed because of the acoustic resonances in
nasal cavity behind the nasal valve region. Effects
of some important anatomical landmarks on AR
cross-sectional area–distance curves are summarized below.
5
4
NNVICMCMS
)
3
2
2
Area (cm
1
0
0123456789101
-1
rhinometry fails to quantify the volume change after
decongestion (CT cross-sectional area–distance curve as
determined by computed tomography, AR cross-sectional
area–distance curve as determined by acoustic rhinometry, N nostril, NV nasal valve, IC head of the inferior concha [turbinate], MC head of the middle concha [turbinate],
FS frontal sinus ostium, MS maxillary sinus ostium)
FS
Choana
CT
AR
anterior narrow segment might signicantly limit
the role of AR as a diagnostic tool for the entire
nasal cavity.
As mentioned above, the nasal valve is identied by a pronounced minimum (the rst minimum after the nostril) on the AR area–distance
curve. Experimental studies on pipe models and
nasal cavity models have shown that AR gives an
accurate measure of the distance from the nose
adapter to the narrow segment that simulates
26.6.1 Nasal Valve
nasal valve, and AR measurements of the anterior
nasal passage are reasonably accurate if the nasal
The nasal valve area is widely accepted as the
most important part of the nasal passage with
respect to its essential role in respiratory physiology. Boundaries of this triangular region are
formed by the caudal septum (medial wall),
caudal edge of the upper lateral cartilages and
head of the inferior turbinate (lateral wall) and
oor of the nose (inferior wall). Nasal valve is the
narrowest part of the nasal passage and functions
as an essential regulator of nasal airow. The
accuracy of AR measurements in the anterior part
of the nose, which contains the nasal valve, is
substantial in terms of the value of this method in
rhinology. Individual anatomical variations of the
valve area is within normal adult ranges [7, 11].
Clinical studies that compare the cross-sectional
areas derived by AR and by imaging modalities,
such as computed tomography and magnetic resonance imaging, also showed that AR is a valuable method for measuring nasal valve area [10,
18, 20–24]. These studies noted signicant cor-
relations between the cross-sectional areas
obtained by imaging modalities and AR, with
particularly high agreement in the anterior part of
the nasal cavity and nasal valve. For the area of
the nasal valve, agreement between the AR and
imaging techniques was apparent when imaging
was obtained perpendicular to the acoustic axis
ab
Distance (cm) Distance (cm)
112
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6
5
4
)
2
3
Area (cm
2
1
0
Fig. 26.7 The cross-sectional area–distance curves of a
nasal cavity before and after decongestion, as determined
by computed tomography (a) and acoustic rhinometry (b).
Actual locations of the anatomical structures before and
after decongestion are determined on computed tomography sections and depicted on the graphs with arrows.
Acoustic rhinometry fails to detect the localizations of the
CT - before decongestion
CT - after decongestion
NV
NV
IC
0
12
3
IC
45
Choana
FS
MC
MS
MS
Choana
FS
678910 11 12
that follows the curve of the nasal passage
through the centre of the curved airway [10].
One of the best-recognized problems with
acoustic pulse response analysis is its inability to
precisely measure the cross-sectional areas
beyond narrow apertures. Concomitantly, the
accuracy of AR measurements of the nasal cavity
depends greatly on nasal passage anatomy, especially that of the narrowest section. In model studies, the cross-sectional area and the length of the
narrow segment have been shown to be the factors
that most signicantly inuence the accuracy of
AR [6]. When the cross-sectional area and the
length of the narrowest part of the passage were
relatively small and short, the probability of measurement error was higher. It is well established
that the area of a region beyond a severe constriction may not be measured accurately by AR, and
a narrowing in the anterior part of the nasal cavity
causes errors in AR-derived areas posterior to the
site of constriction [1, 7, 16, 26, 27]. The results
obtained for living human subjects suggest that,
when the nasal valve passage area is within the
normal adult range, AR is a valuable method for
measuring the cross- sectional areas of the nasal
8
7
6
5
)
2
4
3
Area (cm
2
1
0
anatomical structures except for the nostril and nasal
valve. (CT cross-sectional area–distance curve as determined by computed tomography, AR cross-sectional area–
distance curve as determined by acoustic rhinometry, N
nostril, NV nasal valve, IC head of the inferior concha
[turbinate], MC head of the middle concha [turbinate], FS
frontal sinus ostium, MS maxillary sinus ostium)
AR - before decongestion
AR - after decongestion
Choana
FS
IC
NV
NV
0
12345678 9101
MC
MS
MS
MCMC
FS
IC
Choana
cavity anterior to the paranasal sinus ostia [18,
19]. In other terms, accuracy of AR measurements
is closely related with the narrowest section of the
nasal passage, the nasal valve, and the passage
area of the nasal valve is the most important limiting factor when quantifying the geometry of the
anterior nasal cavity with AR.The effects of nasal
valve passage area on accuracy of AR measurements were examined by Cankurtaran etal. using
simple pipe models with a constriction [7]. These
authors demonstrated that the constriction reects
most of the incident sound power. In models with
constrictions of small passage area, the highfrequency components of the acoustic pulse generated by AR equipment do not reach the portion
of the model beyond the constriction, because
these waves are reected back from the barrier
created by the constriction. This nding is of vital
importance for AR because the transmitted sound
waves probe and hence provide information
about, the cross-sectional area posterior to the
constriction. Accordingly, an examiner should
expect relatively higher degrees of error when
measuring the cross-sectional area of a nasal cavity model beyond a constriction of small passage
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E. Hizal and O. Cakmak
area. Since AR measures the intensity of reected
sound waves and compares this with the intensity
of incident waves, AR-measured cross- sectional
areas beyond the constriction (a nasal valve that is
smaller than normal adult size) are underestimated and the corresponding area–distance curve
shows pronounced oscillations [6, 11].
The anatomy of the human nose is complex,
and the spectrum of individual differences is
broad. For patients with pathologies that narrow
the nasal valve, such as septal deviations, polyps,
tumours, webs, strictures, or alar cartilage insufciencies, the value of AR for measuring the
entire nasal cavity is limited. All users of this
technique must be aware of the effects of nasal
valve to prevent misinterpretation of AR ndings
during clinical assessment.
Together with the nasal valve, the second
important anatomical structure that affects the
AR measurements is paranasal sinuses.
26.6.2 Paranasal Sinuses
To interpret the AR measurements correctly, it is
essential to know how paranasal sinuses affect
AR area–distance curves and to what extent the
AR measurements give idea on paranasal sinus
and their ostia. At this point, the effect of nasal
valve on AR measurements should be noticed
once more. Model studies revealed that as the
area of the nasal valve decrease (<0.283cm2), the
areas of both the nasal valve and regions posterior to the nasal valve are underestimated and
oscillations appear [6, 7, 10, 11]. Clinical studies
on healthy humans supported the results of the
experimental studies and showed that AR gives
reliable results between the nostrils and sinus
ostia if the nasal valve area is in normal range
[18, 19]. Even if the nasal valve area is within
normal range, the areas posterior to the sinus
ostia are overestimated and the degree of error
increases for the areas that are located more
posteriorly.
Clinical and experimental studies revealed
that AR measurements behind 5–6 cm, where
sinus ostia are located, can include signicant
mistakes and AR measurements cannot give
accurate information about the paranasal sinuses
and sinus ostia [6, 8, 11, 19]. The effects of paranasal sinus volume and their ostia on AR measurements have been assessed with model studies,
in detail [8, 11]. The pipe models that have been
used for that purpose were consisting of a main
pipe with a side branch as Helmholtz resonator.
The neck diameter (simulating sinus ostium) and
the cavity volume (simulating the paranasal
sinus) were variable. The results of those studies
showed that small ostia had little impact on AR
measurements, regardless of sinus volume [8,
11]. However, AR overestimated cross-sectional
areas posterior to the simulated sinus ostium
when the ostium was large. Overestimation was
more pronounced as the diameter of the sinus
ostium and volume of the sinus increased. This
result suggests that for patients who have a large
sinus ostium and large paranasal sinus volume
(i.e. after functional endoscopic sinus surgery),
the precision of AR measurements beyond the
sinus ostium is lower. Paranasal sinus volume can
inuence the area–distance curve beyond the
ostium, but this effect is signicant only when the
sinus is connected to the nasal cavity by a relatively large opening [11].
Since AR cannot measure the cross-sectional
areas on posterior nasal cavity correctly, it also
cannot give accurate data on nasal cavity volume.
The results of a clinical study revealed that AR
overestimates nasal cavity volume by 21% before
decongestion and 24% after decongestion, when
compared with volume measured by CT [18].
The nasal cavity volume difference with decongestion was 30% more in AR measurements,
when compared with CT measurements [18]. In
other words, AR overestimates the effect of
decongestion on nasal cavity erectile tissue mass.
In order to understand the reasons of the area
overestimation behind the sinus ostia, it is essential to review the physical properties of the AR
technique once more. The reason for area overestimations is not the acoustic energy loss to the
sinuses through the ostia, but it is the interaction
between the nasal cavity and paranasal sinuses
[19]. The physical principle of AR is based on the
reections of the sound waves that propagate in a
pipe [1, 26–28]. As the cross-sectional areas
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change within the pipe, sound waves are partially
reected and the changes in acoustic impedance
at each point constitute a reection series.
Reection series of the pipe is termed as the
“input impulse response of the pipe” and crosssectional areas are calculated as a function of the
distance [1, 29, 30]. Experimental data that
include input impulse response is transformed
into cross-sectional area–distance curve by the
Ware–Aki algorithm [5]. Sound waves that pass
through the nasal valve are exposed to multiple
reections at localizations with acoustic impedance changes, such as sinus ostia. Oscillations
that are formed by the resonator characteristics of
paranasal sinuses are also superimposed with the
waves that are reected from the posterior parts
of the nasal cavity. The Ware–Aki algorithm
misinterprets superimposed waves and this leads
to area overestimations. Previous experimental
studies showed that complex acoustic resonances
of the paranasal sinuses and nasal cavity and thus
the acoustic resonance effects of sinuses and posterior nasal cavity are not accounted in Ware–Aki
algorithm, which is still used in AR calculations
[8]. The results from healthy humans also showed
that the reason of area overestimations behind the
paranasal sinus ostia was not sound loss through
the sinus ostia to the sinuses, in both nondecongested and decongested cavities [19].
In summary AR does not give reliable data on
the dimensions of the paranasal sinus ostia, volumes of the sinuses, nasal cavity volumes
between nostril and choana and the effect of the
decongestion on nasal mucosa. AR overestimates
the cross-sectional areas behind the sinus ostia.
The diagnostic value of this method is restricted
with the anterior part of the nasal cavity. Thus,
the volume measurements in any instance should
be done for the area between 0 and 5–6cm.
26.7 Applications ofAcoustic
Rhinometry
A simple search on the Medline/PubMed database with the words “acoustic rhinometry” reveals
more than 1100 studies between 1989 and 2020.
Together with the need for an objective tool to
evaluate nasal patency, some attractive factors,
such as relative ease of use and low application
costs, seem to keep this technique as a popular
tool for research. Theoretically, acoustic rhinometry can be used to assess the geometry of nasal
airway and the effect of anatomical, physiological
or pathological conditions that interfere with
nasal patency.
AR has been used to assess the effects of environmental factors (effect of temperature [31, 32],
posture [33], nasal cycle [34], inhaled pollutants,
gases or particles [3]), pharmacological agents
(decongestants [35, 36], antibiotics [37], steroids
[38–40], nasal irrigations [41], antiallergic drugs
[42–44], systemic drugs [45], nasal challenge testing [46]) and surgical therapies on nasal airway. It
also has been used in evaluation of allergic and
non-allergic rhinitis, snoring and sleep apnoea [47,
48]. AR can be a useful tool for evaluation of the
symptom of nasal obstruction, and for documenting the pre-treatment status and post-treatment
outcomes of surgical or medical therapies, for both
medical and medicolegal purposes [49–52].
Acoustic rhinometry has been shown to be
reproducible in animal studies, both invivo and
post mortem [53, 54]. However, physical and
technical improvements for more accurate and
applicable results and modication and optimization of the equipment for measurement of small
dimensions [55] are necessary to use this technique in animal studies.
Acoustic rhinometry has also been used for
measurements in children [56–59]. Due to the
uncomplicated and non-invasive nature of the
technique, it may prove to be a useful tool in
examination of the airways in children. However,
the dimensions of the nasal cavity and thus the
nasal valve in this population are usually much
smaller than those of the adults. Accordingly, limitations of the technique and the validity of measurements should always be kept in mind [60, 61].
26.8 Conclusion
In conclusion, AR is potentially helpful in dening the geometry of nasal cavity, measurement of
nasal patency and assessment of the results of
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E. Hizal and O. Cakmak
nasal medical and surgical interventions.
However, AR measurements can include signicant mistakes due to the operator’s technique and
nasal passage anatomy. AR measures the crosssectional areas in anterior part of the nose with
high accuracy and overestimates the crosssectional areas behind the paranasal sinus ostia.
In other terms, diagnostic value of the technique
is limited with the anterior part of the nasal cavity. Nasal valve can be identied as a minimum
on AR area–distance curves (rst minimum after
the nostril). The second, third and fourth minima
on AR area–distance curves cannot be associated
with an anatomical structure in nasal cavity.
These minima are formed because of the acoustic
resonances in nasal cavity behind the nasal valve
region. The cross-sectional areas behind the paranasal sinus ostia are overestimated with AR.This
is not because of the sound loss to the sinuses
through the sinus ostia, but because of the interactions between the nasal cavity and paranasal
sinuses. Acoustic rhinometry cannot give quantitative data about the volumes of the paranasal
sinuses and dimensions of the sinus ostia, neither
before nor after decongestion. Acoustic rhinometry signicantly overestimates the effect of
decongestion on nasal mucosa. Clinical studies
that do not take the potential errors of AR into
account can easily be misinterpreted. Physical
limitations should be taken into account to
develop better AR equipment and related computer software.
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JG, editors. Fundamentals of noise and vibration.
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