Inferior meatus augmentation procedure (IMAP) normalizes nasal airflow patterns in empty nose syndrome patients via computational fluid dynamics (CFD) modeling.

Autor: Malik J; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH., Dholakia S; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA., Spector BM; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH., Yang A; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA., Kim D; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA., Borchard NA; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA., Thamboo A; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA., Zhao K; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH., Nayak JV; Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.
Jazyk: angličtina
Zdroj: International forum of allergy & rhinology [Int Forum Allergy Rhinol] 2021 May; Vol. 11 (5), pp. 902-909. Date of Electronic Publication: 2020 Nov 29.
DOI: 10.1002/alr.22720
Abstrakt: Background: Empty nose syndrome (ENS) is a controversial upper airway disorder most commonly associated with tissue loss from the inferior turbinates. The inferior meatus augmentation procedure (IMAP) has been shown to effectively reduce ENS symptoms in a durable manner, but the precise mechanisms that may govern this symptomatic improvement remain unknown.
Methods: Five patients with ENS who underwent bilateral IMAP via submucosal costal cartilage implant were assessed. Pre-implant and 6 months post-implant computed tomography (CT) imaging for each ENS patient was analyzed in a blinded fashion using computational fluid dynamics (CFD) modeling to investigate intrapatient changes in airflow parameters.
Results: Following surgery, ENS patients have significantly improved symptoms as indexed by Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) scoring (pre-implant: 14.00 ± 4.06 [mean ± standard deviation]; 95% confidence interval [CI], 10.44 to 17.56; post-implant: 4.8 ± 2.77; 95% CI, 2.37 to 7.23; Cohen's d = 2.64; p = 0.02). Using CFD, a significant shift in nasal airflow patterns was observed, where airflow deviates away from the middle meatus upon hitting the implant (pre-implant: 67.13% ± 11.14%; 95% CI, 60.22% to 74.04%; post-implant: 46.18% ± 12.81%; 95% CI, 38.23% to 54.12%; d = 1.74; p < 0.05) toward the inferior meatus (pre-implant: 30.55% ± 11.29%; 95% CI, 23.55% to 37.55%; post-implant: 42.59% ± 9.60%; 95% CI, 36.63 to 48.54%; d = 1.14; p < 0.05). No significant changes were found in nasal resistance (pre-implant: 0.102 ± 0.015; 95% CI, 0.092 to 0.112 Pa*s/mL; post-implant: 0.105 ± 0.041; 95% CI, 0.081 to 0.130 Pa*s/mL). In addition, the improvement of ENS6Q scoring significantly correlated with percent reduction in aberrant airflow through the middle meatus (R 2 = 0.60, p = 0.04).
Conclusion: This study supports our prior working hypothesis that disordered vectors of nasal airflow congregate in the middle meatus contribute to ENS symptoms, not nasal resistance. Moreover, these data illuminate a paradoxical, but consistent, restoration of nasal airflow to the inferior meatus following the replacement of turbinate tissue volume in the inferior meatus via IMAP surgery, potentially due to the Coandă effect.
(© 2020 ARS-AAOA, LLC.)
Databáze: MEDLINE
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