Quantitative evaluation of the orofacial morphology:
anthropometric measurements in healthy and mouth-breathing children.
Cattoni DM, Fernandes FD, Di Francesco RC, De Latorre Mdo R.
International Journal Orofacial Myology. 2009 Nov;35:44-54.
Craniocervical posture and hyoid bone position in children with mild
and moderate asthma and mouth breathing.
Chaves TC, de Andrade E Silva TS, Monteiro SA, Watanabe PC, Oliveira
AS, Grossi DB.
International Journal Pediatr Otorhinolaryngol. 2010 Jun 19.
Polysomnographic findings are associated with cephalometric
measurements in mouth-breathing children.
Juliano ML, Machado MA, de Carvalho LB, Zancanella E, Santos GM, do
Prado LB, do Prado GF.
Journal Clin Sleep Med. 2009 Dec 15;5(6):554-61.
The impact of speech therapy on asthma and allergic rhinitis control in
mouth breathing children and adolescents.
Campanha SM, Fontes MJ, Camargos PA, Freire LM.
Journal Pediatr (Rio J). 2010 May-Jun;86(3):202-8.
[Prevalence of mouth breathing in children from an elementary school]
Felcar JM, Bueno IR, Massan AC, Torezan RP, Cardoso JR.
Cien Saude Colet., 2010 Mar;15(2):437-44.
in vertical dentofacial morphology after adeno-tonsillectomy during
deciduous and mixed dentitions mouth breathing children--1 year
Souki BQ, Pimenta GB, Franco LP, Becker HM, Pinto JA.
Intern Journal Pediatrics Otorhinolaryngol. 2010 Jun;74(6):626-32.
Mouth breathing: adverse effects on facial growth, health, academics,
General Dentstry 2010 Jan-Feb;58(1):18-25; quiz 26-7, 79-80.
Mouth breathing children have cephalometric patterns similar to those
of adult patients with obstructive sleep apnea syndrome.
Juliano ML, Machado MA, de Carvalho LB, do Prado LB, do Prado GF.
Arq Neuropsiquiatr. 2009 Sep;67(3B):860-5.
Orientation and position of head posture, scapula and thoracic spine in
Neiva PD, Kirkwood RN, Godinho R.
Intern Journal Pediatr Otorhinolaryngol. 2009 Feb;73(2):227-36.
Mouth breathing increases the pentylenetetrazole-induced seizure
threshold in mice: a role for ATP-sensitive potassium channels.
Niaki SE, Shafaroodi H, Ghasemi M, Shakiba B, Fakhimi A, Dehpour AR.
Epilepsy Behav. 2008 Aug;13(2):284-9.
Enforced mouth breathing decreases lung function in mild asthmatics.
Hallani M, Wheatley JR, Amis TC.
Respirology. 2008 Jun;13(4):553-8.
The relationship between excursion of the diaphragm and curvatures of
the spinal column in mouth breathing children.
Yi LC, Jardim JR, Inoue DP, Pignatari SS.
Journal Pediatr (Rio J). 2008 Mar-Apr;84(2):171-7.
[Characteristics of the stomatognathic system of mouth breathing
children: anthroposcopic approach]
Cattoni DM, Fernandes FD, Di Francesco RC, Latorre Mdo R.
Pro Fono. 2007 Oct-Dec;19(4):347-51. Portuguese.
Aust J Sci Med Sport. 1995 Sep;27(3):51-5.
Comparison of maximal oxygen consumption with oral and nasal breathing.
Morton AR, King K, Papalia S, Goodman C, Turley KR, Wilmore JH.
University of Western Australia, Perth, Australia.
The major cause of exercise-induced asthma (EIA) is thought to be the
drying and cooling of the airways during the 'conditioning' of the
inspired air. Nasal breathing increases the respiratory system's
ability to warm and humidity the inspired air compared to oral
breathing and reduces the drying and cooling effects of the increased
ventilation during exercise. This will reduce the severity of EIA
provoked by a given intensity and duration of exercise. The purpose of
the study was to determine the exercise intensity (%VO2 max) at which
healthy subjects, free from respiratory disease, could perform while
breathing through the nose-only and to compare this with mouth-only and
mouth plus nose breathing. Twenty subjects (11 males and 9 females)
ranging from 18-55 years acted as subjects in this study. They were all
non-smokers and non-asthmatic. At the time of the study, all subjects
were involved in regular physical activity and were classified, by a
physician, as free from nasal polyps or other nasal obstruction. The
percentage decrease in maximal ventilation with nose-only breathing
compare to mouth and mouth plus nose breathing was three times the
percentage decrease in maximal oxygen consumption. The pattern of
nose-only breathing at maximal work showed a small reduction in tidal
volume and large reduction in breathing frequency. Nasal breathing
resulted in a reduction in FEO2 and an increase in FECO2. While
breathing through the nose-only, all subjects could attain a work
intensity great enough to produce an aerobic training effect (based on
heart rate and percentage of VO2 max).
Rhinology. 2007 Jun;45(2):102-11.
Observations on the ability of the nose to warm and humidify inspired
Naclerio RM, Pinto J, Assanasen P, Baroody FM.
Department of Surgery, Section of Otolaryngology-Head and Neck Surgery,
The University of Chicago, Chicago, IL 60637, USA.
The major function of the nose is to warm and humidify air before it
reaches to the lungs for gas exchange. Conditioning of inspired air is
achieved through evaporation of water from the epithelial surface. The
continuous need to condition air leads to a hyperosmolar environment on
the surface of the epithelium. As ventilation increases, the
hyperosmolar surface moves more distally, covering a larger surface
area of the airway, and stimulates epithelial cells to release
mediators that lead to inflammation. This inflammation is not identical
to allergic inflammation, but causes both short-term and long-term
changes in the epithelium. In the short-term, it increases paracellular
water transport in an attempt to enhance conditioning, and it
stimulates sensory nerves to initiate neural reflexes. It also disrupts
channels in the cellular membrane, which might permit greater
penetration of foreign proteins, such as allergens, leading to further
inflammatory cascades. The long-term inflammation induced over time by
the hyperosmolar milieu could worsen the ability of the nose to
condition air, requiring more of the conditioning to occur in the lower
airway and leading to adverse consequences for the respiratory system.
Improved nasal breathing reduces snoring and morning tiredness. A 6-month
Archives of Otolaryngology and Head and Neck Surgery. 1996 Dec; 122(12):
Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
BACKGROUND: Dilation of the nasal valve region can increase the ability to
breathe through the nose and reduce the negative intrathoracic pressure required
for inspiration. Vibrations of the palate and soft tissues of the throat, which
generate snoring sounds, can be prevented when patients inhale less heavily.
OBJECTIVES: To evaluate the effect a nostril dilator has on patient snoring and
tiredness in the morning and to determine how many patients would continue to
use the device for half a year. DESIGN: For 6 months, 42 men who were heavy
snorers graded their average tiredness in the morning and the patient's sleeping
partner graded the average snoring using a visual analog scale from 0 to 100.
SETTING: All patients were examined at the Department of Otorhinolaryngology,
Central Hospital, in Skövde, Sweden. RESULTS: When the nostril dilator was used
there was a significant decrease in snoring after both 1- and 6-month reports.
There was a significant correlation between diminution of snoring and less
tiredness in patients in the morning. The compliance was good since 60% of
patients continued to use the device during the 6-month resistance during sleep
has on snoring and morning tiredness in patients.
Enforced mouth breathing decreases lung function in mild asthmatics,
Respirology 2008 Jun; 13(4): p.553-558.
Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute,
Sydney, New South Wales, Australia
BACKGROUND AND OBJECTIVE: Nasal breathing provides a protective influence
against exercise-induced asthma. We hypothesized that enforced oral breathing in
resting mild asthmatic subjects may lead to a reduction in lung function.
METHODS: Asymptomatic resting mild asthmatic volunteers (n = 8) were instructed
to breathe either nasally only (N; tape over lips) or orally only (O; nose clip)
for 1 h each, on separate days. Lung function (% predicted FEV(1)) was measured
using standard spirometry at baseline and every 10 min for 1 h. 'Difficulty in
breathing' was rated using a Borg scale at the conclusion of the N and O
periods. RESULTS: Baseline FEV(1) on the N (101.2 +/- 3.8% predicted) and O
(102.7 +/- 3.9% predicted) days was not significantly different (P > 0.3). At 60
min, FEV(1) on the O day (96.5 +/- 4.1% predicted) was significantly less than
on the N day (101.0 +/- 3.5% predicted; P < 0.009). On the N day, FEV(1) did not
change with time (P > 0.3), whereas on the O day, FEV(1) fell progressively
(slope = -0.06 +/- 0.01% FEV(1)/min, P < 0.0001; linear mixed effects
modelling). Three subjects experienced coughing/wheezing at the end of the O day
but none experienced symptoms at the end of the N day. Subjects perceived more
'difficulty breathing in' at the end of the O day (1.5 +/- 0.4 arbitrary units)
than on the N day (0.4 +/- 0.3 arbitrary unit; P < 0.05). CONCLUSIONS: Enforced
oral breathing causes a decrease in lung function in mild asthmatic subjects at
rest, initiating asthma symptoms.
Petruson B, Theman K,
Reduced nocturnal asthma by improved nasal breathing,
Acta Otolaryngol. 1996 May; 116(3): p.490-492.
Department of ENT, Sahlgrenska University Hospital, Göteborg, Sweden.
The nose and not the mouth should be used for breathing as the nose has
better air conditioning capacity. When air is inhaled through the mouth it may
dry and cool the respiratory mucosa, which can lead to bronchoconstriction in
sensitive patients with asthma. By dilating the nostrils you can increase nasal
breathing in most subjects. The aim of this study was to investigate whether
sleeping with dilated nostrils reduces nocturnal asthma. At the Asthma and
Allergy Research Centre, Gothenburg, 15 out-patients with nocturnal asthma were
selected. Every other night for 10 nights the test subjects slept with the nasal
dilator Nozovent which has been shown to increase the nasal air-flow and
decrease the need for mouthbreathing. Every morning the patients self-reported
on a form whether they had woken with asthma during the night or if they had had
to take asthma medication. When sleeping with the nasal dilator the patients
woke up with asthma on 17 of 75 nights as compared with 32 of 75 when sleeping
without the device (p < 0.01). Reduced nocturnal asthma was observed by 12
patients and less need for asthma medication at night by 7. None of the patients
noted any side-effects due to the device. In conclusion, the easy-to-use and
cheap medical device, Nozovent, which mechanically dilates the nostrils and
improves nasal breathing, can reduce nocturnal asthma.
Nasal breathing, sleep apnoea,
Increased nasal breathing decreases snoring and improves oxygen saturation
during sleep apnea,
Rhinology. 1994 Jun; 32(2): p.87-89.
ENT Department, Sahlgren's Hospital, University of Göteborg, Sweden.
For many years ENT-specialists have performed surgery to create a good air
passage in patients with different kinds of nasal deformities. When having a
blocked nose one realizes the importance of being able to breathe through the
nose. By moving the nasal wings aside with the fingers, or the medical device
Nozovent, most people experience that it is easier to breathe through the nose
than ever before, which can also be shown with rhinomanometry. When it is easier
to inhale there is less energy in the air passing the palate which means less
risk for vibrations creating snoring sounds. In different studies it has been
possible to show that snoring can be decreased or prevented when the nasal
dilator Nozovent is used. It has also been shown to result in a decrease of the
sleep apnea index and improvement of arterial oxygen saturation during sleep
Obligatory nasal breathing: effects on snoring and sleep apnea,
Med J Aust. 1991 Jul 15; 155(2): p.83-85.
Department of Thoracic Medicine, Royal Adelaide Hospital, North Terrace, SA,
OBJECTIVE: To test the effects on snoring and sleep disordered breathing of a
dental prosthesis (Snore-No-More) which is designed to decrease snoring by
preventing mouth breathing during sleep. DESIGN: A crossover controlled trial.
Each subject was studied on two nights a week apart. There was a control (no
treatment) night and an experimental (treatment) night. The order of control and
experimental nights was randomized. SETTING: The Royal Adelaide Hospital Sleep
Laboratory. PARTICIPANTS: Fourteen male volunteers (age range, 36-59 years) were
studied. All had a history of chronic snoring but denied other symptoms of
obstructive sleep apnea syndrome. INTERVENTIONS: On experimental nights
subjects wore the dental prosthesis for the whole study period. On control
nights no device was worn. MAIN OUTCOME MEASURES: Studies were conducted
overnight during the subject's normal sleep period. The following measurements
were made: (i) frequency and loudness of snores; (ii) frequency of disordered
breathing events (apnoeas and hypopnoeas); (iii) mean and minimum arterial
oxygen saturation while asleep; and (iv) sleep stages. RESULTS: The dental
prosthesis did not change the mean frequency or mean intensity of snores. The
number of sleep disordered breathing events per hour of sleep decreased by
approximately one-third on experimental nights (mean +/- SEM events/h: control,
24.7 +/- 5.3; experimental, 16.1 +/- 3.3, P less than 0.05). Neither sleep
architecture nor arterial oxygen saturation differed between control and
experimental nights. CONCLUSION: Snores using the dental prosthesis
Snore-No-More to produce obligatory nasal breathing are unlikely to experience
Gleeson K, Zwillich CW, Braier K, White DP,
Breathing route during sleep,
Am Rev Respir Dis 1986 Jul;
Nasal obstruction has been associated with apneic episodes during sleep.
However, the normal distribution of nasal and oral air flow while asleep has not
been investigated. To determine the normal route of ventilation during sleep, we
studied 7 healthy men and 7 healthy women using a sealed face mask that
mechanically separated nasal and oral air flow. Standard sleep staging
techniques were employed. The subjects slept 297 +/- 29 (SEM) min, with a mean
of 197 +/- 15 min of ventilation recorded. Ventilation was decreased during
sleep as has been previously demonstrated. However, during sleep, we found that
men breathed a greater percentage of total ventilation through the mouth (29.0
+/- 8.2%) than did women (5.0 +/- 1.0%, p less than 0.02). The same trend
applied during wakefulness but did not reach significance (p = 0.06). Although
none was symptomatic, 4 subjects, all men, had more than 3 apneas per hour.
These 4 men had a greater percentage of mouth ventilation (37.3 +/- 19.0%) than
did the other 10 subjects with few or no apneas (8.1 +/- 2.7%, p less than
0.02). It was also noted that increasing age in men was associated with an
increasing percentage of mouth ventilation (r = 0.83 p less than 0.03) but this
relationship was not observed in women. We conclude that mouth breathing may be
associated with apneas during sleep and that breathing through the mouth occurs
commonly in men, particularly in those who are older. This suggests that nasal
breathing may be important in the maintenance of ventilatory rhythmicity during
[Physiopathology of mouth breathing. Snoring and apnea][Article in French]
Centre Hospitalier de La Citadelle, Liège, Belgique.
Oral breathing causes changes in pulmonary mechanics as well as in the
pressure of arterial blood gases. In response to increased nasal obstruction oro-nasal
breathing occurs. The level of oro-nasal partitioning maintains an adequate
level of respiratory resistance. Sleep disordered breathing, although not only
related to oral breathing, is a common disorder. When upper airway resistance is
increased limitation of flow occurs. Snoring indicates a mild degree of reduced
airflow. Sleep apnea occurs when upstream pressure falls below a critical
pressure (Pcrit). The mechanisms are reviewed.
Nasal congestion and hyperventilation
Nasal congestion and hyperventilation syndrome,
Am J Rhinol. 2005 Nov-Dec; 19(6): p.607-611.
Waitemata District Health Board, Auckland, New Zealand.
BACKGROUND: This article evaluates the prevalence of hyperventilation
syndrome (HVS) in patients who continue to complain of ongoing nasal congestion,
despite an apparently adequate surgical result and appropriate medical
management. METHODS: Prospective case series of 14 patients from June 2002 to
October 2003 was performed. Patients, who presented complaining of nasal
congestion after previous nasal surgery and who appeared to have an adequate
nasal airway with no evidence of nasal valve collapse, were evaluated for HVS.
When appropriate, nasal steroids and oral antihistamines also had been tested
without success. Three patients had end-tidal P(CO2) levels measured and five
patients underwent breathing reeducation. RESULTS: All patients had an elevated
respiratory rate (>18 breaths/minute) with an upper thoracic breathing pattern.
Twelve of the 14 patients complaining of nasal obstruction had an elevated
Nijmegen score indicative of HVS. An average number of 2.5 procedures had been
performed on each patient. End-tidal P(CO2) levels were < or = 35 mmHg in the
three patients who had expired P(CO2) levels measured. Breathing retraining was
successful in correcting the nasal congestion in two of five patients.
CONCLUSION: HVS should be included in the differential diagnosis of patients
presenting with nasal congestion, particularly after failed nasal surgery. One
possible explanation is increased nasal resistance secondary to low arterial
P(CO2) levels. Another possible explanation is reduced alae nasae muscle
activity secondary to the reduced activity of serotonin-containing raphe
neurons. Additional surgery may not necessarily be the answer in HVS patients
complaining of nasal congestion.
Nasal breathing as a treatment for hyperventilation: relevance of hemispheric
Br J Clin Pract. 1989 Apr;43(4): p.161-162.
[The importance of normal nasal breathing for the physical and mental
development of man and for diseases of the respiratory tract],
Munch Med Wochenschr. 1957 Sep 27; 99(39): p.1405-1408 (in German).