Subject:
Rhinomanometry and Acoustic/Optical Rhinometry
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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Rhinomanometry, acoustic rhinometry and optical rhinometry are techniques to objectively measure nasal patency. Several clinical applications are proposed including allergy testing, evaluation of obstructive sleep apnea and patient assessment prior to nasal surgery.
Background
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. Three techniques that could potentially be useful in measuring nasal patency are as follows:
Rhinomanometry is a computerized assessment 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.
Regulatory Status
Ten models of rhinomanometers or acoustic rhinometers received marketing clearance by the U.S. Food and Drug Administration (FDA) 510(k) mechanism between 1984 and 2002. Optical rhinometry is a technique developed in Europe and so far, no devices had received clearance for marketing in the United States.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
Rhinomanometry and acoustic/optical rhinometry are considered investigational.
Medicare Coverage:
There is no National Coverage Determination (NCD) or Local Coverage Determination (LCD) for jurisdiction JL for this service. Therefore, Medicare Advantage Products will follow the Horizon BCBSNJ Medical Policy.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
(NOTE: 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. Therefore, the technologies are considered investigational.)
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Rhinomanometry and Acoustic/Optical Rhinometry
Rhinomanometry
Rhinomanometer
Acoustic Rhinometry
Acoustic Rhinometer
Rhinometry
Rhinometer
Optical Rhinometry
Optical Rhinometer
References:
1. Schumacher MJ. Nasal congestion and airway obstruction: the validity of available objective and subjective measures. Curr Allergy Asthma Rep 2002; 2(3):245-51.
2. 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.
3. 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.
4. Ellegard EK, Hellgren M, Karlsson NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol 2001; 26(5):394-400.
5. 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.
6. Suzina AH, Hamzah M, Samsudin AR. Objective assessment of nasal resistance in patients with nasal disease. J Laryngol Otol 2003; 117(8):609-13.
7. Numminen J, Dastidar P, Heinonen T et al. Reliability of acoustic rhinometry. Respir Med 2003; 97(4):421-7.
8. Mamikoglu B, Houser SM, Corey JP. An interpretation method for objective assessment of nasal congestion with acoustic rhinometry. Laryngoscope 2002; 112(5):926-9.
9. 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.
10. 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.
11. 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.
12. Wüstenberg EG, Zahnert T, Hüttenbrink 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.
13. 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.
14. 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.
15. 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.
16. Thulesius HL, Cervin A, Jessen M. Can we always trust rhinomanometry? Rhinology. 2011 Mar;49(1):46-52.
17. Cannon DE, Rhee JS. Evidence-based practice: functional rhinoplasty. Otolaryngol Clin North Am. 2012 Oct;45(5):1033-43.
18. de Aguiar Vidigal T, Martinho Hadded FL et al. Subjective, anatomical, and functional nasal evaluation of patients with obstructive sleep apnea syndrome. Sleep Breath. 2013 Mar;17(1):427-33.
19. Dadgarnia MH, Baradaranfar MH et al. Assessment of Septoplasty Effectiveness using Acoustic Rhinometry and Rhinomanometry. Iran J Otolaryngol. 2013 Spring;25(71):71-8.
20. Rosenfeld RM, Ander D, Bhattacharyya N et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007 Sep;137(3 suppl):S1-31).
21. Rhee JS, Weaver EM, Park SS et al. Clinical consensus statement: Diagnosis and management of nasal valve compromise. Otolaryingol Head Neck Surg. 2010 Jul;143(1):48-59.
22. Aziz T, Biron VL et al. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014 Apr 24;43:11.
23. Patuzzi R, Cook A. Acoustic impedance rhinometry (AIR): A technique for monitoring dynamic changes in nasal congestion. Physiol Meas. 2014;35(4):501-515.
24. Lange B, Thilsin22. Haavisto LE, Sipilä JI. Acoustic rhinometry, rhinomanometry and visual analogue scale before and after septal surgery: a prospective 10-year follow-up. Clin Otolaryngol. 2013 Feb;38(1):23-9.
25. Clement PA, Halewyck S et al. Critical evaluation of different objective techniques of nasal airway assessment: a clinical review. Eur Arch Otorhinolaryngol. 2014 Oct;271(10):2617-25.
26. Baelum J, et al. Acoustic rhinometry in persons recruited from the general population and diagnosed with chronic rhinosinusitis according to EPOS. Eur Arch Otorhinolaryngol. 2014;271(7):1961-1966.
27. UpToDate. Bhattacharyya N, Deschler DG, Sokol HN. Clinical presentation, diagnosis, and treatment of nasal obstruction. Literature review current through May 2015, topic last updated: Nov 17, 2014 (last accessed 06/26/2015).
28. Bhattacharyya N. Clinical presentation, diagnosis, and treatment of nasal obstruction. In: UpToDate, Deschler DG, Sullivan DJ (Eds), UpToDate, Waltham, MA. (Accessed November 4, 2017.)
29. Bhattacharyya N. Clinical presentation, diagnosis, and treatment of nasal obstruction. In: UpToDate, Deschler DG, Kunins L (Eds), UpToDate, Waltham, MA. (Accessed October 5, 2018.)
30. Lotz DR, Slavin RG. Occupational rhinitis. In: UpToDate, Corren J, Feldweg AM (Eds), UpToDate, Waltham, MA. (Accessed October 5, 2018.)
31. Bhattacharyya N. Clinical presentation, diagnosis, and treatment of nasal obstruction. In: UpToDate, Deschler DG, Kunins L (Eds), UpToDate, Waltham, MA. (Accessed October 1, 2019.)
32. Lieberman PL. Chronic nonallergic rhinitis. In: UpToDate, Corren J, Feldweg AM (Eds), UpToDate, Waltham, MA. (Accessed October 1, 2019.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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