Nasal nitric oxide measurements before and after repeated humming maneuvers


  • Department of Pharmacology and Physiology (M. Maniscalco, J. O. N. Lundberg), and Department of Anaesthesiology (E. Weitzberg), Karolinska Institute, Stockholm, Sweden; Section of Respiratory Medicine, Hospital ‘S. Maria della Pietà’, Casoria, Naples, Italy (M. Maniscalco); Department of Respiratory Medicine, A.O. Monaldi, University ‘Federico II’, Naples, Italy (M. Sofia, L. Carratu).

Mauro Maniscalco, MD, L.go delle Mimose 1, 80131 Napoli, Italy. Tel.: +39 3381779679; fax: +39 0817411457; e-mail:


Background  It has been recently shown that humming greatly increases nasal nitric oxide (NO). This is most likely owing to a rapid washout of sinus NO caused by the oscillating sound waves. During repeated humming manoeuvres nasal NO gradually decreases, likely because NO accumulated in the sinuses is washed out.

Aim  We studied whether humming before measurements would affect nasally exhaled NO.

Materials and methods  NO output was measured by the chemiluminescence technique in orally and nasally exhaled air in 38 subjects: 18 healthy subjects (HS), 15 subjects with allergic rhinitis (AR) and five subjects with allergic nasal polyposis (AP). Each subject performed a NO measurement during quiet nasal exhalation either preceded by a period of silence/free speaking or immediately after five consecutive humming manoeuvres (posthumming).

Results  Mean nasal NO output (95% CI) after a period of silence/free speaking was 231 nL min−1 (178–284) in HS, 434 nL min−1 (347–522) in AR (P < 0·001) and 262 nL min−1 (163–361) in AP. Post-humming nasal NO output was 16% (5 to 50%) lower in HS and 14% (1 to 49%) lower in AR, while it remained unchanged in AP subjects. Intra-subject coefficient of variation of quiet nasal exhalation was 12% in HS, 13% in AR and 5% in AP. Post humming intraindividual coefficient of variation significantly decreased in both HS and AR, but it did not change in AP.

Conclusions  Nasal NO levels measured immediately after repeated humming manoeuvres are consistently lower and more reproducible than nasal NO levels measured after a period of silence or free speaking. Repeated humming effectively empties the sinuses, thereby probably minimizing the normal contribution from the sinuses to nasal NO. This may be useful to better estimate NO output from the nasal cavity mucosa in health and disease.