Several studies have reported on various cytokines that correlate to the chronic rhinosinusitis with nasal polyps phenotype; however, more insight into the mechanisms that lead to altered cytokine profiles and the nasal polyps phenotype is needed.

This is the first CFD examination of nasal aerodynamics in a large cohort of ENS patients. The results indicated that a combination of loss of neural sensitivity and poorer inferior air-mucosal stimulation may potentially lead to ENS symptomology.

Our novel classification and landmarks system helps to understand the anatomy of this complex area and to accurately plan the EETA.

Objective The precise pathogenesis of empty nose syndrome (ENS) remains unclear. Various factors such as nasal aerodynamics and sensorineural dysfunction have been suspected, yet, evidence is limited. This study reported the first examination of both nasal aerodynamics and trigeminal sensory factors in actual ENS patients. Study Design Prospective case control. Methods We enrolled 6 patients diagnosed with ENS. Three patients had pre- and post-inferior turbinate (IT) reduction computed tomography (CT) scans, which allowed comparison of their nasal aerodynamics changes through Computational Fluid Dynamic (CFD) simulation. Their symptoms were confirmed through SNOT-22, ENS6Q, acoustic rhinometry and rhinomanometry findings. Nasal trigeminal sensitivity that potentially mediates their perception of airflow, was assessed via menthol lateralization detection thresholds (LDT) and compared with 14 healthy controls. Results Post-surgical reductions in nasal resistance were observed and significantly lower than normal (p<0.05). CFD analysis showed that, paradoxically for all ENS patients, IT reduction did not draw more airflow to the airway surrounding the ITs, but rather resulted in nasal airflow forming into a narrow jet towards the middle meatus region, leaving the airway surrounding the inferior turbinate with significantly reduced airflow intensity and air-mucosal interactions (inferior region flow percentage reduced from 35.7%±15.9% to post-surgery 17.7%±15.7, p<0.05; inferior wall-shear-stress, reduced from 7.5±4.2×10−2 Pa to 3.4±3.1×10−2 Pa, p<0.01). ENS patients also had significantly impaired menthol LDT compared to healthy controls (p<0.005). Conclusion The results indicated that a combinatory of factors, including paradoxically distorted nasal aerodynamic, impaired sensorineural sensitivity, and potential pre-disposing conditions, may contribute to the development of ENS.

OBJECT Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence. CONCLUSIONS Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.