Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation

Malik, Jennifer; Spector, Barak M; Wu, Zhenxing; Markley, J Thomas; Zhao, Songzhu; Otto, Bradley A.; Farag, Alexander A.; Zhao, Kai

doi:10.1002/lary.29673

Cited by 17 publications

(18 citation statements)

References 37 publications

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“…In addition, the sensation of mucosal cooling in the nasal cavity was assumed to be an essential factor that affects patient-reported nasal obstruction. Previous studies investigated the hypothesis that subjective patency correlated better with mucosal cooling than with NR [ 12 – 14 , 18 ]. The role of the vestibule area in sensing nasal patency was also reported by Willatt and Jones [ 31 ] and Sullivan et al [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of various criteria to define mucosal cooling, as discussed in several studies [ 17 , 18 , 22 , 32 , 33 ], suggests the need for more sophisticated outcome measures for surgery. Table 5 shows that RH and air temperature at the posterior end of the septum decreased for all subjects after surgery, despite the significant improvement in patient-reported patency ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…The computational fluid dynamics (CFD) technique has become a valuable tool in characterizing the airflow and air conditioning capacity of the nasal cavity because it overcomes the difficulty of measuring the pressure and intranasal epithelial surface temperature in vivo . Although CFD has been used to investigate NAO resulting from NSD [ 15 – 18 ], few studies have used it to predict flow modification after septoturbinoplasty [ 19 – 22 ]. Therefore, changes in airflow characteristics after surgical correction of NSD are not well understood.…”

Section: Introductionmentioning

confidence: 99%

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Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis

Yang

Kim

et al. 2022

PLoS ONE

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Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work employs computational fluid dynamics modeling to identify the physical variables and domains associated with symptomatic improvement. Sixteen numerical models were generated using eight patients’ pre- and postoperative computed tomography scans. Changes in unilateral nasal resistance, surface heat flux, relative humidity, and air temperature and their correlations with improvement in the Nasal Obstruction Symptom Evaluation (NOSE) score were analyzed. The NOSE score significantly improved after septoturbinoplasty, from 14.4 ± 3.6 to 4.0 ± 4.2 (p < 0.001). The surgery not only increased the airflow partition on the more obstructed side (MOS) from 31.6 ± 9.6 to 41.9 ± 4.7% (p = 0.043), but also reduced the unilateral nasal resistance in the MOS from 0.200 ± 0.095 to 0.066 ± 0.055 Pa/(mL·s) (p = 0.004). Improvement in the NOSE score correlated significantly with the reduction in unilateral nasal resistance in the preoperative MOS (r = 0.81). Also, improvement in the NOSE score correlated better with the increase in surface heat flux in the preoperative MOS region from the nasal valve to the choanae (r = 0.87) than in the vestibule area (r = 0.63). Therefore, unilateral nasal resistance and mucous cooling in the preoperative MOS can explain the perceived improvement in symptoms after septoturbinoplasty. Moreover, the physical domain between the nasal valve and the choanae might be more relevant to patient-reported patency than the vestibule area.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis

Yang

Kim

et al. 2022

PLoS ONE

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“…Differences in trigeminal function could affect the surgical result. In a recent study of patients with a symptomatic septal deviation, the nasal heat flux (cooling) and menthol lateralisation test was distorted compared with subjects having a septal deviation without symptoms or no septal deviation at all ( 27 ). This implies that interest should primarily focus on anterior abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…If a similar non-invasive technique were available for nasal airflow, it would probably increase our diagnostic accuracy and potentially the surgical results. Computional fluid dynamics (CFD) is an emerging and promising technique to study nasal airflow that may change this situation in the future ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Unmet challenges in septoplasty–nordic studies from a uniform healthcare and geographical area

et al. 2022

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PurposeNasal septoplasty is one of the most common surgical procedures in otorhinolaryngology and optimising both patient selection and the surgery is a challenge. The Nordic countries have similar public healthcare systems and comparable populations in terms of size.MethodsThis is a review of studies of outcome and predictors related to septoplasty from Denmark, Finland, Norway and Sweden, published during the last decade. The aim of this review was to identify areas in need of further research to meet the challenges of septoplasty in the Nordic countries with reference to international data.ResultsPostoperative patient satisfaction at 6–12 months was reported in around 2/3 of the patients and well in line with international data. Patients with more severe symptoms had a higher chance of improvement. Lack of standardisation in patient selection, surgical methods and skills, and follow up procedures, still makes it difficult to explain the 25% failure rate in septoplasty surgery.ConclusionThis review of the Nordic studies from the last decade shows that septoplasty in general is effective in relieving nasal obstruction. There is a need for studies addressing the standardisation of diagnostic tools and algorithms and the systematic and continuous implementation of follow-up of the surgical results at both departmental and personal level. This includes an awareness of how surgical skills in septoplasty are obtained and maintained.

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Oxymetazoline as a predictor of turbinate reduction surgery outcomes: Objective support from a prospective, single‐blinded, computational fluid dynamics study

Root,

Wu,

Lepley

et al. 2024

Int Forum Allergy Rhinol

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BackgroundA patient's subjective response to topical nasal decongestant is often used to screen for turbinate reduction surgery suitability. However, this anecdotal strategy has not been objectively and quantitatively evaluated.MethodsProspective, longitudinal, and single‐blinded cohort study employing computational fluid dynamic modeling based on computed tomography scans at baseline, 30 min postoxymetazoline, and 2 months postsurgery on 11 patients with chronic turbinate hypertrophy.ResultsNasal obstruction symptom evaluation (NOSE) and visual analogue scale (VAS) obstruction scores significantly improved from baseline to postoxymetazoline and again to postsurgery (NOSE: 71.82 ± 14.19 to 42.27 ± 25.26 to 22.27 ± 21.04; VAS: 6.09 ± 2.41 to 4.14 ± 2.20 to 2.08 ± 1.56; each interaction p < 0.05), with significant correlation between the latter two states (r∼0.37–0.69, p < 0.05). Oxymetazoline had a broader anatomical impact throughout inferior and middle turbinates than surgery (many p < 0.05); however, the improvement in regional airflow is similar (most p > 0.05) and predominantly surrounding the inferior turbinate. Strong postoxymetazoline to postsurgery correlations were observed in decreased nasal resistance (r = 0.79, p < 0.05), increased regional airflow rates (r = ‐0.47 to −0.55, p < 0.05) and regional air/mucosa shear force and heat flux (r = 0.43 to 0.58, p < 0.05); however, only increasing peak heat flux significantly correlated to symptom score improvement (NOSE: r = 0.48, p < 0.05).ConclusionWe present the first objective evidence that the “topical decongestant test” can help predict turbinate reduction surgery outcomes. The predictive effect is driven by similar improvementin regional airflow that leading to improved air/mucosa stimulations (peak heat flux) rather than through reduced nasal resistance.

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Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation

Cited by 17 publications

References 37 publications

Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis

Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis

Unmet challenges in septoplasty–nordic studies from a uniform healthcare and geographical area

Oxymetazoline as a predictor of turbinate reduction surgery outcomes: Objective support from a prospective, single‐blinded, computational fluid dynamics study

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