The cotton test redistributes nasal airflow in patients with empty nose syndrome

Autor:	Jennifer Malik, Jayakar V. Nayak, Nicole A. Borchard, Andrew Thamboo, Sachi S. Dholakia, Sam McGhee, Chengyu Li, Kai Zhao
Rok vydání:	2020
Předmět:	Meatus Airflow Nose Turbinates Article 03 medical and health sciences 0302 clinical medicine Airway resistance Nose Diseases otorhinolaryngologic diseases medicine Empty nose syndrome Humans Immunology and Allergy Computer Simulation In patient 030223 otorhinolaryngology Sinus (anatomy) business.industry Syndrome medicine.disease medicine.anatomical_structure 030228 respiratory system Otorhinolaryngology Hydrodynamics Nasal airflow Nasal Obstruction Iohexol Tomography X-Ray Computed Nuclear medicine business medicine.drug
Zdroj:	Int Forum Allergy Rhinol
ISSN:	2042-6984 2042-6976
DOI:	10.1002/alr.22489
Popis:	BACKGROUND Empty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Cotton placement into the inferior meatus often alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by cotton testing. METHODS Six ENS patients (12 sides) with pre-existing sinus computed tomography (CT) imaging were enrolled after marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6-Item Questionnaire [ENS6Q] of >7 points) with office-based cotton testing. The fashioned cotton plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect cotton contouring in the inferior meatus. CT imaging from pre- and post-cotton placement was analyzed using comparative CFD techniques. RESULTS After cotton placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 ± 4.1 to 3.1 ± 2.4; p < 0.001) were recorded. Using CFD, cotton placement produced an expected 21% increase in upper airway resistance (p < 0.05). However, a significant shift in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (-41%; p < 0.002). CONCLUSION Objective CFD assessment confirmed that the cotton test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of cotton test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::98776d912ba9fe4d909ae083fc218209 https://doi.org/10.1002/alr.22489 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
Nepřihlášeným uživatelům se plný text nezobrazuje	K zobrazení výsledku je třeba se přihlásit.