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

Abstract

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.

Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea

“…Another study showed that the nasal valve volume and angle were increased using magnetic resonance imaging [49]. In addition, a computational fluid dynamics study comparing nasal resistance and airflow changes before and after septal surgery decreased total nasal resistance after surgery by 50% compared to before surgery [50]. Based on these study results, nasal surgery has been shown to address nasal obstruction in patients wi effectively the OSA.…”

Obstructive sleep apnea for the rhinologist

“…Sinonasal pathologies, such has nasal polyposis and inverted papilloma have been shown to negatively affect OSA and CPAP compliance necessitating adequate disease control in order to improve OSA [30][31][32]33 & ] Surgical correction of nasal obstruction often involves septoplasty, inferior turbinate reduction, and/or internal nasal valve repair. Additionally, in patients with chronic rhinosinusitis, endoscopic sinus surgery can improve mucosal inflammation causing nasal obstruction [34]. The literature has also revealed that nasal surgery in OSA patients can positively impact PAP compliance [35].…”

“…This is thought to be because less PAP pressure is required for maintaining airway patency [35]. In a study evaluating flow dynamics before and after septal surgery, there was also a 50% decrease in total nasal resistance postoperatively [34]. In doing so, nasal surgery helps mitigate the negative pressure gradient that promotes pharyngeal collapse in OSA.…”

The Role of the Biosafety Cabinet in Preventing Infection in the Clinical Laboratory

“…Additional advances in airflow engineering enhance aerosol and particulate containment, strengthening infection control methods. Non-technological research can produce innovative filters with greater efficiency, capable of capturing tiny particles and bacteria [61].…”

“…Additional advances in airflow engineering can result in more effective aerosol and particulate containment, strengthening infection control methods. Innovative filters with even greater efficiency, capable of capturing tiny particles and bacteria, may be produced by non-technological research [ 61 ]. Data tracking, remote monitoring, and automatic maintenance planning could all be made possible with the integration of BSCs with laboratory information systems.…”