ABSTRACT

Importance-Historically, otolaryngologists have focused on nasal resistance to airflow and minimum airspace cross-sectional area as objective measures of nasal obstruction using methods such as rhinomanometry and acoustic rhinometry. However, subjective sensation of nasal patency may be more associated with activation of cold receptors by inspired air than with respiratory effort.Objective-To investigate whether subjective nasal patency correlates with nasal mucosal temperature in healthy subjects.Design, Setting, and Participants-Twenty-two healthy adults were recruited for this study. Subjects first completed the Nasal Obstruction Symptom Evaluation (NOSE) and a unilateral visual analog scale (VAS) to quantify subjective nasal patency. A miniaturized thermocouple sensor was then used to record nasal mucosal temperature bilaterally in two locations along the nasal septum: at the vestibule and across from the inferior turbinate head.Results-The range of temperature oscillations during the breathing cycle, defined as the difference between end-expiratory and end-inspiratory temperatures, was greater during deep breaths (ΔT exp-insp = 6.2 ± 2.6°C) than during resting breathing (ΔT exp-insp = 4.2 ± 2.3°C) in both locations (p < 10 −13 ). Mucosal temperature measured at the right vestibule had a statistically significant correlation with both right-side VAS score (Pearson r = −0.55, p=0.0076) and NOSE

The outcomes of aesthetic and functional nasal surgery are difficult to assess objectively due to the intricate balance between nasal form and function. Despite historical emphasis on patient-reported subjective measures, objective measures are gaining importance in both research and the current outcomes-driven healthcare environment. Objective measures presently available have several shortcomings which limit their routine clinical use. In particular, the low correlation between objective and subjective measures poses a major challenge. However, advances in computer, imaging, and bioengineering technology are now setting the stage for the development of innovative objective assessment tools for nasal surgery that can potentially address some of the current limitations. Assessment of nasal form following aesthetic surgery is evolving from two-dimensional analysis to more sophisticated three-dimensional analysis. Similarly, assessment of nasal function is evolving with the introduction of computational fluid dynamics techniques, which allow for a detailed description of the biophysics of nasal airflow. In this paper, we present an overview of objective measures in both aesthetic and functional nasal surgery and discuss future trends and applications that have the potential to change the way we assess nasal form and function.

Objective To study the effects of nasal deformity on aerosol penetration past the nasal valve (NV) for varying particle sizes using sprays or nebulizers. Study Design Computed mathematical nasal airway model. Setting Department computer lab Subjects and Methods Particle deposition was analyzed using a computational fluid dynamics model of the human nose with leftward septal deviation and compensatory right inferior turbinate hypertrophy. Sprays were simulated for 10µm, 20µm, 50µm, or particle sizes following a Rosin Rammler Particle Size Distribution (10–110µm), at speeds of 1m/s, 3m/s, or 10m/s. Nebulization was simulated for 1µm, 3.2µm, 6.42µm, or 10µm particles. Steady state inspiratory airflow was simulated at 15.7L/min. Results Sprays predicted higher NV penetration on the right side for particle sizes >10µm, with comparable penetration on both sides at 10µm. Nearly 100% deposited in the nasal passages for all spray characteristics. Nebulizer predictions showed nearly 100% of particles <6.42µm and over 50% of 6.42µm bypassing both sides of the nose without depositing. Of the nebulized particles that deposited, penetration was higher on the right at 10µm, with comparable penetration on both sides at 6.42µm. Spray penetration was highest at 10µm, with over 96% penetrating on both sides at 1 and 3m/s. Nebulization penetration was also highest at 10µm (40% on the left, >90% on the right). Conclusion In the presence of a septal deviation, sprays or nebulizers containing 10µm particles may have good penetration beyond the NV. Nebulized particles <10µm are likely to be respirable. Additionally, spray speeds above 3m/s may limit penetration.

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