Archived Policies - Medicine


Rhinomanometry and Acoustic Rhinometry

Number:MED204.004

Effective Date:10-01-2007

End Date:10-14-2013

Coverage:

This policy is no longer scheduled for routine literature review and update.

Rhinomanometry and acoustic rhinometry are considered experimental, investigational and unproven.

Description:

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.

The techniques are proposed for use in comparing decongestive action of antihistamines and corticosteroids and for assessment of the patient prior to nasal surgery.

Ten models of rhinomanometers or acoustic rhinometers have received marketing clearance by the U.S. Food and Drug Administration (FDA) 510(k) mechanism between 1984 and 2002.

Rationale:

A literature search was performed on the MEDLINE database for the period of 1997 through December 2006.  The published literature suggested that both acoustic manometry and rhinomanometry are frequently used in research studies in which objective measurements of nasal obstruction may be important to determine treatment effects.  However, no studies provided a detailed analysis of how these two diagnostic studies would be used in the clinical management of the patient and whether they were more clinically relevant or accurate compared to patient self-assessment.  While patient self-assessment may be difficult in infants and small children, data are insufficient to permit scientific conclusions in this population of patients.  Acoustic rhinometry has also been investigated as a technique to measure nasal valve area.  However, use of this information in the management of patients is unknown.

As described previously, rhinomanometry and acoustic rhinometry are frequently used as objective measurements of treatment efficacy in research studies.  Use of acoustic rhinometry for the diagnosis of allergic rhinitis and surgical evaluation of nasal obstruction has been the topic of recent reviews.  Pilot studies are also being reported for use of acoustic rhinometry in patients with obstructive sleep apnea (OSA) to assess tolerance to nasal continuous positive airway pressure (CPAP).  However, no studies were found that demonstrate how use of these diagnostic procedures would improve outcomes compared to standard approaches, such as patient self-assessment.

A MEDLINE literature review was conducted through August 2007.  Results of this review did not result in any change in the policy statements.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

None

CODING:

Disclaimer for coding information on Medical Policies

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.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

92512

HCPCS Codes

NONE

ICD-9 Diagnosis Codes

Refer to ICD-9-CM Manual

ICD-9 Procedure Codes

89.12

ICD-10 Diagnosis Codes

N/A

ICD-10 Procedure Codes

N/A


Medicare Coverage:

The information contained in this section is for informational purposes only. HCSC makes no representation as to the accuracy of this information.  It is not to be used for claims adjudication for HCSC Plans.

Medicare (CMS) does not have a national coverage position.  Coverage may be subject to local carrier discretion.

A national coverage position for Medicare may have been developed or changed since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

Djupesland, P., and O.F. Pedersen.  Acoustic rhinometry in infants and children.  Rhinology Supplement (2000) 16:52-8.

Larivee, Y., Leon, Z., et al.  Evaluation of the nasal response to histamine provocation with acoustic rhinometry.  Journal of Otolaryngology (2001) 30(6):319-23.

Wilson, A.M., Sims, E.J., et al.  Effects of topical corticosteroid and combined mediator blockade on domiciliary and laboratory measurement of nasal function in seasonal allergic rhinitis.  Annuls of Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology (2001) 87(4):344-9.

Ellegard, E.K., Hellgren, M., et al.  Fluticasone propionate aqueous nasal spray in pregnancy rhinitis.  Clinical Otolaryngology: Official Journal of ENT-UK; Official Journal of the Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (2001) 26(5):394-400.

Rhee, C.S., Kim, D.Y., et al.  Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate.  The Laryngoscope (2001) 111(1):153-8.

Mamikoglu, B., Houser, S.M., et al.  An interpretation method for objective assessment of nasal congestion with acoustic rhinometry.  The Laryngoscope (2002) 112(5):926-9.

Schumacher, M.J.  Nasal congestion and airway obstruction: the validity of available objective and subjective measures. Current Allergy and Asthma Reports (2002) 2(3):245-51.

Suzina, A.H., Hamzah, M., et al.  Objective assessment of nasal resistance in patients with nasal disease.  Journal of Laryngology and Otology (2003) 117(8):609-13.

Numminen, J., Dastidar, P., et al.  Reliability of acoustic rhinometry.  Respiratory Medicine (2003) 97(4):421-7.

Cakmak, O., Coskun, M., et al.  Value of acoustic rhinometry for measuring nasal valve area.  The Laryngoscope (2003) 113(2):295-302.

Ciprandi, G., Marseglia, G.L., 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.

Nathan, R.A., Eccles R., et al.  Objective monitoring of nasal patency and nasal physiology in rhinitis.  Journal of Allergy and Clinical Immunology (2005)115(3 pt 2):S442-59.

Ceroni Campadretti, G., Tasca, I., et al.  Acoustic rhinometric measurements in children undergoing rapid maxillary expansion.  International Journal of Pediatric Otorhinolaryngology (2005 June 12).

Priftis, K.N., Drigopoulos, K., et al.  Subjective and objective nasal obstruction assessment in children with chronic rhinitis. International Journal of Pediatric Otorhinolaryngology (2005 September 8).

Cakmak, O., Tarhan, E., et al. Acoustic rhinometry: accuracy and ability to detect changes in passage area at different locations in the nasal cavity in the nasal cavity. The Annals of Otology, Rhinology, and Laryngology (2005 December) 114 (12):949-57.

Corey, J.P.  Acoustic rhinometry: should we be using it? Current Opinion in Otolaryngology & Head and Neck Surgery (2006) 14(1):29-34.

Uzzaman, A., Metcalfe, D.D., et al.  Acoustic rhinometry in the practice of allergy.  Annuls of  Allergy, Asthma & Immunology: Official Publication of the American College of Allergy, Asthma, & Immunology (2006) 97(6):745-51.

Morris, L.G., Setlur, J., et al.  Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study.  American Journal of Rhinology (2006) 20(2):133-7.

Rhinomanometry and Acoustic Rhinometry. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2007 February) Medicine 2.01.08

Policy History:

Archived Document(s):

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