Description
Rhinomanometry, acoustic rhinometry, and optical rhinometry are considered nasal function studies and are techniques to objectively measure nasal patency. Several clinical applications are proposed including for use in allergy testing, comparing decongestive action of antihistamines and corticosteroids, for evaluation of obstructive sleep apnea, and for patient assessment prior to nasal surgery.

Nasal patency is a complex clinical issue that can involve mucosal, structural, and psychological factors. The perception of nasal obstruction is subjective and does not always correlate with clinical examination of the nasal cavity, making it difficult to determine which therapy might be most likely to restore satisfactory nasal breathing. Therefore, procedures that objectively measure nasal patency have been sought. Discussion of 3 techniques that could potentially be useful in measuring nasal patency follows.
 
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 uses 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. This technique is based on the absorption of red/near-infrared light by hemoglobin and the endonasal swelling-associated increase in local blood volume.
 
Acoustic pharyngometry also uses acoustic reflection for volume analysis of oro-pharynometric parameters to establish a correlation between morpho-volumetric variations of oro-pharyngo-laryngeal spaces and the presence and severity of disease. Acoustic pharyngometry is a method of investigating obstruction in sleep disordered breathing together with other exams such as cephalometrics, computed tomography, magnetic resonance imaging and fibro-nasopharngolaryngoscopy etc. It is also used to monitor medical and surgical treatments for the management of obstructive sleep apnea. 

Acoustic Pharyngometer The Eccovision^® Acoustic Pharyngometer (Sleep Group Solutions) is a device that uses acoustic reflection technology to measure the patient’s pharyngeal airway size and stability from the Oral Pharyngeal Junction to the Glottis. Sound waves are projected down the airway and reflected back in such a way that the Pharyngometer software can analyze and quantify changes in the airways cross-sectional area. The data is graphically displayed showing the relationship between the cross-sectional area of the airway and distance in centimeters. Studies suggest a relationship between the existence of obstructive sleep apnea and a narrow, collapsible, airway. However, the utility of acoustic pharyngometry measurement in the clinical setting of OSA has not been demonstrated, and it remains unclear how this test will impact treatment planning and clinical outcomes. The test is completed with the patient awake and seated during the exam, which takes 2 – 5 minutes to complete. 

Acoustic Rhinometer The Eccovision^® Acoustic Rhinometer (Sleep Group Solutions) also uses acoustic reflection technology and measures nasal patency and maps out the topography of the nasal airway identifying the location and severity of airway obstruction. The test is completed with the patient awake and seated during the exam which takes 30 seconds to complete. The utility of acoustic rhinometry measurement in the clinical setting of OSA has not been demonstrated, and it remains unclear how this test will impact treatment planning and clinical outcomes.  

Policy
Rhinomanometry and acoustic or optical rhinometry are considered investigational and/or unproven and therefore NOT MEDICALLY NECESSARY as there is insufficient evidence in the published medical literature to demonstrate safety, efficacy, and long-term outcomes.

Acoustic pharyngometry is considered investigational and/or unproven and therefore is NOT MEDICALLY NECESSARY as technique for screening, diagnosis, or treatment planning in persons with known or suspected obstructive sleep apnea (OSA) as there is insufficient evidence in the published medical literature to demonstrate safety, efficacy, and long-term outcomes. [NOTE: CPT code 92520, Laryngeal function studies; aerodynamic testing and acoustic testing is not considered appropriate for this service]. 

Rationale
Overall, the scientific evidence does not permit conclusions about the effect of rhinomanometry, acoustic rhinometry or optical rhinometry on net health outcome. To date, no studies have been published that evaluate the clinical utility of these tests. That is, none of the studies identified have prospectively compared patient outcomes with and without the use of one or more of these tests for any clinical condition.

References

1. Andre RF, Vuyk HD, Ahmed A et al. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009; 34(6):518- 25. 
2. Bhattacharyya, N. Nasal obstruction: diagnosis and management. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated January 11, 2022. 
3. Canakcioglu S, Tahamiler R, Saritzali G et al. Nasal patency by rhinomanometry in patients with sensation of nasal obstruction. Am J Rhinol Allergy 2009; 23(3):300-2.
4. 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. 
5. 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. 
6. Clinical Trials.gov. (2010, February 16) Assessment of the Impact of a Stepped Mouthpiece on the Upper Airways Measured Through Acoustic Pharyngometry. Last updated December 7, 2011. 
7. Clinical Trials.gov. (2010, October 14) Acoustic Pharyngometry in Obstructive Sleep Apnea Syndrome Patients, With Indication of Continuous Positive Air Pressure (APOSAS). 
8. Ellegard EK, Hellgren M, Karlsson NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol 2001; 26(5):394-400. 
9. 9. Epstein, L J, Kristo D, Strollo PJ, et al. Clinical guideline for the evaluation, management, and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 5(3):263-276. 
10. Larivee Y, Leon Z, Salas-Prato M et al. Evaluation of the nasal response to histamine provocation with acoustic rhinometry. J Otolaryngol 2001; 30(6):319-23. 
11. Mamikoglu B, Houser SM, Corey JP. An interpretation method for objective assessment of nasal congestion with acoustic rhinometry. Laryngoscope 2002; 112(5):926-9. 
12. 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. 
13. National Center on Sleep Disorders Research. 
14. Numminen J, Dastidar P, Heinonen T et al. Reliability of acoustic rhinometry. Respir Med 2003; 97(4):421-7. 
15. Pawar, S et al. Objective Measures in Aesthetic and Functional Nasal Surgery-Perspectives on Nasal Form and Function. Facial Plast Surg. 2010 August; 26(4):320-327. 
16. Pirila T, Tikanto J. Acoustic rhinometry and rhinomanometry in the preoperative screening of septal surgery patients. Am J Rhinol Allergy 2009; 23(6): 605-9. 
17. 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(1):153-8. 
18. Schumacher MJ. Nasal congestion and airway obstruction: the validity of available objective and subjective measures. Curr Allergy Asthma Rep 2002; 2(3):245-51. 
19. Suzina AH, Hamzah M, Samsudin AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol 2003; 117(8):609-13 
20. 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(4):344-9. 
21. 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. 
22. Kendzerska T, Grewal M, Ryan CM. Utility of Acoustic Pharyngometry for the Diagnosis of Obstructive Sleep Apnea. Ann Am Thorac Soc. 2016;13(11):2019-2026. doi:10.1513/AnnalsATS.201601-056OC. 
23. Blue Cross Blue Shield Association Medical Policy Reference Manual. 2.01.08, Rhinomanometry and Acoustic Optical Rhinometry. Archived. March 2010.

Coding Section

NOTE: Claims submitted for nasal function studies (CPT code 92512) and laryngeal function studies (CPT 92520) will suspend for medical review.

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.

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