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Introduction-Empty nose syndrome (ENS) is a rare and debilitating disease with controversial definition, etiology and treatment. One puzzling fact is that patients who undergo an endoscopic endonasal approach (EEA) often receive resection of multiple anatomical structures, yet seldom develop ENS. In this pilot study, we analyzed and compared the computational fluid dynamics (CFD) and symptoms among patients following EEA, ENS patients and healthy cohorts. Methods-CT scans of four post-EEA patients were collected and analyzed utilizing CFD techniques. Two had significant ENS symptoms based on an ENS6Q questionnaire (score >11), while the other two were asymptomatic. As a reference, their results were compared to previously published CFD results of 27 non-EEA ENS patients and 42 healthy controls. Results-Post-EEA patients with ENS symptoms had a similar nasal airflow pattern as non-EEA ENS patients. And this pattern, significantly differed from that of EEA patients without ENS symptoms and healthy controls. Overall, groups with ENS symptoms exhibited airflow dominant in the middle meatus region and significantly less percentage of airflow in the inferior turbinate region (EEAwENS:17.74%±4.00% vs EEAw/oENS:51.25%±3.33%, t-test p<0.02; non-EEA ENS: 25.8±17.6%; healthy:36.5±15.9%) as well as lower peak wall-shear-stress (EEAwENS:0.30±0.13 vs EEAw/oENS:0.61±0.03, p=0.003; non-EEA ENS:0.58±0.24; healthy:1.18±0.81 Pa). Conclusion-These results suggest that turbinectomy and/or posterior septectomy may have a varying functional impact and that ENS symptoms go beyond anatomy, but rather correlate with aerodynamic changes. The findings open the door for CFD as potential objective diagnosis of ENS.
Introduction-Empty nose syndrome (ENS) is a rare and debilitating disease with controversial definition, etiology and treatment. One puzzling fact is that patients who undergo an endoscopic endonasal approach (EEA) often receive resection of multiple anatomical structures, yet seldom develop ENS. In this pilot study, we analyzed and compared the computational fluid dynamics (CFD) and symptoms among patients following EEA, ENS patients and healthy cohorts. Methods-CT scans of four post-EEA patients were collected and analyzed utilizing CFD techniques. Two had significant ENS symptoms based on an ENS6Q questionnaire (score >11), while the other two were asymptomatic. As a reference, their results were compared to previously published CFD results of 27 non-EEA ENS patients and 42 healthy controls. Results-Post-EEA patients with ENS symptoms had a similar nasal airflow pattern as non-EEA ENS patients. And this pattern, significantly differed from that of EEA patients without ENS symptoms and healthy controls. Overall, groups with ENS symptoms exhibited airflow dominant in the middle meatus region and significantly less percentage of airflow in the inferior turbinate region (EEAwENS:17.74%±4.00% vs EEAw/oENS:51.25%±3.33%, t-test p<0.02; non-EEA ENS: 25.8±17.6%; healthy:36.5±15.9%) as well as lower peak wall-shear-stress (EEAwENS:0.30±0.13 vs EEAw/oENS:0.61±0.03, p=0.003; non-EEA ENS:0.58±0.24; healthy:1.18±0.81 Pa). Conclusion-These results suggest that turbinectomy and/or posterior septectomy may have a varying functional impact and that ENS symptoms go beyond anatomy, but rather correlate with aerodynamic changes. The findings open the door for CFD as potential objective diagnosis of ENS.
Nasal airflow that effectively transports ambient odors to the olfactory receptors is important for human olfaction. Yet, the impact of nasal anatomical variations on airflow pattern and olfactory function is not fully understood. In this study, 22 healthy volunteers were recruited and underwent computed tomographic scans for computational simulations of nasal airflow patterns. Unilateral odor detection thresholds (ODT) to l-carvone, phenylethyl alcohol (PEA) and d-limonene were also obtained for all participants. Significant normative variations in both nasal anatomy and aerodynamics were found. The most prominent was the formation of an anterior dorsal airflow vortex in some but not all subjects, with the vortex size being significantly correlated with ODT of l-carvone (r = 0.31, P < 0.05). The formation of the vortex is likely the result of anterior nasal morphology, with the vortex size varying significantly with the nasal index (ratio of the width and height of external nose, r = -0.59, P < 0.001) and nasal vestibule "notch" index (r = 0.76, P < 0.001). The "notch" is a narrowing of the upper nasal vestibule cartilage region. The degree of the notch also significantly correlates with ODT for PEA (r = 0.32, P < 0.05) and l-carvone (r = 0.33, P < 0.05). ODT of d-limonene, a low mucosal soluble odor, does not correlate with any of the anatomical or aerodynamic variables. The current study revealed that nasal anatomy and aerodynamics might have a significant impact on normal olfactory sensitivity, with greater airflow vortex and a narrower vestibule region likely intensifying the airflow vortex toward the olfactory region and resulting in greater olfactory sensitivity to high mucosal soluble odors.
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