Trigeminal endonasal perception – an outcome predictor for septoplasty

Bischoff, Sven; Poletti, Sophia C.; Kunz, Seraina M; Kiessling, S; Hinder, D.; Dreher, A.; Akdis, C A; Soyka, Michael

doi:10.4193/rhin19.292

Cited by 8 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other words, our results suggest that the trigeminal system, which is known to be involved in airflow perception (17) , plays a role in the pathogenesis of CNO. Our results further support previous observations that underline the importance of identifying patients with poor intranasal trigeminal sensitivity prior to nasal surgery (8,24) .…”

Section: Discussionsupporting

confidence: 92%

“…It has been suggested that an altered perception of nasal patency in CNO may be caused by altered afferent neural pathways responsible for airflow perception (4) . Low intranasal trigeminal function seems to predict poor postoperative satisfaction after septal surgery (8) , underling the implication of airflow perception in nasal obstruction.…”

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Trigeminal impairment in treatment-refractory chronic nasal obstruction

Migneault-Bouchard¹,

Boselie²,

Hugentobler³

et al. 2021

Rhin

View full text Add to dashboard Cite

BACKGROUND: Patients with anatomically unexplained, chronic nasal obstruction (CNO) that is refractory to medical treatment pose a challenge for clinicians. A surgical solution, addressing mechanical obstacles, is unsuited for these patients. CNO may result from disrupted airflow perception due to activation of the intranasal trigeminal system; therefore, aim of this study is to evaluate if intranasal trigeminal function of these CNO patients is decreased. METHODS: In this retrospective cross-sectional study, we compared 143 CNO patients and 58 healthy volunteers, between 18 to 80 years old. We assessed nasal patency by means of rhinomanometry (RM) and measured susceptibility of intranasal trigeminal system by the trigeminal lateralization task (TLT). RESULTS: TLT scores were significantly lower in CNO patients compared to controls (p less than 0.001), but RM scores were not different between groups. Accordingly, TLT allowed to identify CNO patients with an accuracy of the area under the curve (AUC) of 0.78, while the value for RM was at chance (AUC=0.47). CNO patients showed normal reaction to vasoconstrictive agents with significantly lower RM values after Xylomethazoline application. CONCLUSION: Results suggest that reported nasal obstruction in CNO patients without any obvious anatomical obstacle and resistant to medical treatment may be linked to decreased perception of nasal airflow rather than physical obstruction. In this sub-set of CNO patients, trigeminal testing more adequately reflects the reported obstruction than nasal resistance assessment does. In future studies, the relation of the trigeminal status and the subjective sensation of nasal obstruction needs to be addressed with validated patient rated outcome measures (PROMs).

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 96%

Trigeminal impairment in treatment-refractory chronic nasal obstruction

Migneault-Bouchard¹,

Boselie²,

Hugentobler³

et al. 2021

Rhin

View full text Add to dashboard Cite

show abstract

“…The missing gap may be the lack of information about trigeminal function. Ultimately, an improvement of more than 3 VAS points after septoplasty can be predicted by a lateralisation test score of >31.5 (88% sensitivity) [16].…”

Section: Discussionmentioning

confidence: 99%

“…However, it seems more practical to assess intranasal trigeminal function only in specific rhinological conditions at clinical practice. For example, it can be initially used in patients for whom there is evidence of potential low trigeminal sensitivity such as patients scheduled for septoplasty, patients with empty nose syndrome, patients with nasal obstruction without specific clinical findings, patients suspected of having olfactory dysfunction [6,[10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Intranasal Function of the Trigeminal Nerve in Daily Clinical Practice

Garefis,

Markou,

Chatziavramidis

et al. 2024

ORL

View full text Add to dashboard Cite

Background: The trigeminal nerve is a mixed cranial nerve responsible for the motor innervation of the masticatory muscles and the sensory innervation of the face, including the nasal cavities. Through its nasal innervation, we perceive sensations, such as cooling, tingling and burning, while the trigeminal system mediates the perception of airflow. However, the intranasal trigeminal system has received little attention in the clinical evaluation of patients with nasal pathology. Summary: Testing methods that enable the clinical assessment of intranasal trigeminal function have recently been developed. This study aims to present the current clinical methods that can be utilised in everyday practice, as described in the literature. These methods include four assessment techniques: 1) The quick screening test of trigeminal sensitivity involves patients rating the intensity of ammonium vapour presented in a lipstick-like container. 2) The lateralisation test requires subjects to identify which nasal cavity is being stimulated by a trigeminal stimulus, such as eucalyptol or menthol, while the other side receives an odorless stimulus. 3) The trigeminal sticks test evaluates the trigeminal function similarly to the olfactory function using sticks filled with trigeminal stimulant liquids. 4) The automated CO₂ stimulation device is used for measuring trigeminal pain thresholds, utilising intranasal CO₂ stimuli to define the pain threshold. Key Messages: Assessing intranasal trigeminal function clinically may prove useful in evaluating rhinology patients, particularly those who encounter nasal obstruction without anatomical blockage and those experiencing olfactory disorders with suspected trigeminal dysfunction. Despite their limitations, the presented methods may provide useful information about nasal patency, chemosensitivity and pain sensation in the daily clinical practice of such patients, leading to better therapeutic decisions.

show abstract

“…Recently, Migneault-Bouchard et al (58) showed that trigeminal function appears to be more informative than mechanical resistance in patients with treatment refractory nasal obstruction, and Bischoff et al (59) published data suggesting that intranasal trigeminal function predicts satisfaction after septoplasty.…”

Section: Trpm8 Importance For Intranasal Trigeminal Functionmentioning

confidence: 99%

Rhinology in review: from COVID-19 to biologicals

Fokkens¹,

Landis²,

Hopkins³

et al. 2021

Rhin

View full text Add to dashboard Cite

We look back at the end of what soon will be seen as an historic year, from COVID-19 to real-world introduction of biologicals influencing the life of our patients. This review describes the important findings in Rhinology over the past year. A large body of evidence now demonstrates loss of sense of smell to be one of the most common symptoms of COVID-19 infection; a meta-analysis of 3563 patients found the mean prevalence of self-reported loss to be 47%. A number of studies have now shown long-term reduced loss of smell and parosmia. Given the high numbers of people affected by COVID-19, even with the best reported recovery rates, a significant number worldwide will be left with severe olfactory dysfunction. The most prevalent causes for olfactory dysfunction, besides COVID-19 and upper respiratory tract infections in general, are trauma and CRSwNP. For these CRSwNP patients a bright future seems to be starting with the development of treatment with biologics. This year the Nobel prize in Medicine 2021 was awarded jointly to David Julius and Ardem Patapoutian for their discoveries of receptors for temperature and touch which has greatly enhanced our understanding of nasal hyperreactivity and understanding of intranasal trigeminal function. Finally, a new definition of chronic rhinitis has been proposed in the last year and we have seen many papers emphasizing the importance of endotyping patients in chronic rhinitis and rhinosinusitis in order to optimise treatment effect.

show abstract

Trigeminal endonasal perception – an outcome predictor for septoplasty

Cited by 8 publications

References 30 publications

Trigeminal impairment in treatment-refractory chronic nasal obstruction

Trigeminal impairment in treatment-refractory chronic nasal obstruction

Assessment of Intranasal Function of the Trigeminal Nerve in Daily Clinical Practice

Rhinology in review: from COVID-19 to biologicals

Contact Info

Product

Resources

About