Investigation of the abnormal nasal aerodynamics and trigeminal functions among empty nose syndrome patients

Li, Chengyu; Farag, Alexander A.; Maza, Guillermo; McGhee, Sam; Ciccone, Michael A.; Deshpande, Bhakthi; Pribitkin, Edmund A.; Otto, Bradley A.; Zhao, Kai

doi:10.1002/alr.22045

Cited by 84 publications

(140 citation statements)

References 31 publications

(49 reference statements)

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…In fact, a subjectively congested nose may not exclusively have an anatomical origin but might also result from insensitivity of the nasal trigeminal nerve. In this context, it seems possible that the feeling of a decreased patency of the nasal cavity may stem from decreased trigeminal sensitivity [22, 23]. …”

Section: Introductionmentioning

confidence: 99%

Effects of “trigeminal training” on trigeminal sensitivity and self-rated nasal patency

Oleszkiewicz

Schultheiss

Schriever

et al. 2018

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

PurposePatients with the feeling of a congested nose not always suffer from an anatomical obstruction but might just have a low trigeminal sensibility, which prevents them from perceiving the nasal airstream. We examined whether intermittent trigeminal stimulation increases sensitivity of the nasal trigeminal nerve and whether this effect is accompanied by subjective improvement of nasal breathing.MethodThirty-five patients (Mage = 58.4 years; SD = 14.8; Minage = 21 years; Maxage = 79 years; 43% females) and 30 healthy controls (Mage = 36.7 years, SD = 14.5; Minage = 20 years; Maxage = 73 years; 60% females) participated in a study comprised of two sessions separated by “trigeminal training”. During each session, trigeminal sensitivity towards CO2, trigeminal lateralization abilities and ratings of nasal patency were assessed. Age and training compliance were controlled.Results“Trigeminal training” had a positive effect on trigeminal sensitivity in both groups, (p = .027) and this effect depended on the training compliance (p < .001). “Trigeminal training” had no effect on lateralization abilities of the subjects (p > .05). Ratings of nasal patency increased in patients (p = .03), but not in controls.Conclusions“Trigeminal training” consisting of intermittent presentation of diverse stimulants leads to an increase of trigeminal sensitivity, but this effect depended on the training compliance. Importantly, in patients, this training is also associated with an increase in self-rated nasal patency.

show abstract

Section: Introductionmentioning

confidence: 99%

Effects of “trigeminal training” on trigeminal sensitivity and self-rated nasal patency

Oleszkiewicz

Schultheiss

Schriever

et al. 2018

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…ENS is commonly associated with inferior turbinate resection (ITR) and rarely associated with middle turbinate resection . CFD airflow investigations after ITR have demonstrated decreased nasal resistance, increased nasal airflow, and decreased SAHF50 . In patients with ENS, CFD simulation showed that small ITs resulted in decreased airflow intensity around the IT.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, patients with empty nose syndrome (ENS) suffer from nasal airway obstruction, chronic nasal crusting, dryness, and fetid odor. This debilitating disease is associated with, and commonly attributed to, previous intranasal surgery performed to correct nasal airway obstruction . Altered aerodynamics causing abnormal conditioning of nasal airflow are thought to contribute largely to the development of ENS .…”

mentioning

confidence: 99%

“…This debilitating disease is associated with, and commonly attributed to, previous intranasal surgery performed to correct nasal airway obstruction . Altered aerodynamics causing abnormal conditioning of nasal airflow are thought to contribute largely to the development of ENS . Endoscopic CFR represents an extreme of surgically altered sinonasal anatomy and, given this, it is remarkable that these individuals do not commonly endorse symptoms experienced by those with ENS.…”

mentioning

confidence: 99%

“…Numerical simulations of airflow have been shown to approximate in‐vivo conditions and provide objective data about flow patterns, as well as heat and water transfer . CFD has been utilized to evaluate surgical outcomes and to enhance the understanding of disease states, including nasal airway obstruction, septal perforation, and ENS . However, no CFD studies have investigated the effects of CFR on nasal airflow patterns and conditioning.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport

Tracy

Basu

Shah

et al. 2019

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background: Endoscopic craniofacial resections (CFR) are performed for extensive anterior skull base lesions. This surgery involves removal of multiple intranasal structures, potentially leading to empty nose syndrome (ENS). However, many patients remain asymptomatic postoperatively. Our objective was to analyze the impact of CFR on nasal physiology and airflow using computational fluid dynamics (CFD). This is the first CFD analysis of post-CFR patients.Methods: Three-dimensional sinonasal models were constructed from 3 postoperative images using Mimics TM . Hybrid computational meshes were created. Steady inspiratory airflow and heat transport were simulated at patientspecific flow rates using shear stress transport k-omega turbulent flow modeling in Fluent TM . Simulated average heat flux (HF) and surface area where HF exceeded 50 W/m 2 (SAHF50) were compared with laminar simulations in 9 radiographically normal adults.Results: Three adults underwent CFR without developing ENS. Average HF (W/m 2 ) were 132.70, 134.84, and 142.60 in the CFR group, ranging from 156.24 to 234.95 in the nonoperative cohort. SAHF50 (m 2 ) values were 0.0087, 0.0120, and 0.0110 in the CFR group, ranging from 0.0082 to 0.0114 in the radiographically normal cohort. SAHF50 was distributed throughout the CFR cavities, with increased HF at the roof and walls compared with the nonoperative cohort. Conclusion:Average HF was low in the CFR group compared with the nonoperative group. However, absence of ENS in most CFR patients may be due to large stimulated mucosal surface area, commensurate with the nonoperative cohort. Diffuse distribution of stimulated area may result from turbulent mixing a er CFR. To be er understand heat transport post-CFR, a larger cohort is necessary. C 2019 ARS-AAOA, LLC.

show abstract

Can a postnasal drip be aspirated into the lungs?

Wormald¹

2018

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Investigation of the abnormal nasal aerodynamics and trigeminal functions among empty nose syndrome patients

Abstract: 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.

Cited by 84 publications

References 31 publications

Effects of “trigeminal training” on trigeminal sensitivity and self-rated nasal patency

Effects of “trigeminal training” on trigeminal sensitivity and self-rated nasal patency

Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport

Can a postnasal drip be aspirated into the lungs?

Contact Info

Product

Resources

About