Jennifer Malik1, Andrew Thamboo2, Sachi Dholakia3, Nicole A Borchard3, Sam McGhee1, Chengyu Li4, Kai Zhao1, Jayakar V Nayak3. 1. Department of Otolaryngology, Head & Neck Surgery, The Ohio State University, Columbus, OH. 2. Department of Otolaryngology, Head & Neck Surgery, University of British Columbia, Vancouver, Canada. 3. Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, CA. 4. Department of Mechanical Engineering, Villanova University, Villanova, PA.
Abstract
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.
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.
Authors: Chengyu Li; Alexander A Farag; Guillermo Maza; Sam McGhee; Michael A Ciccone; Bhakthi Deshpande; Edmund A Pribitkin; Bradley A Otto; Kai Zhao Journal: Int Forum Allergy Rhinol Date: 2017-11-22 Impact factor: 3.858
Authors: Jennifer Malik; Chengyu Li; Guillermo Maza; Alexander A Farag; Jillian P Krebs; Sam McGhee; Gabriela Zappitelli; Bhakthi Deshpande; Bradley A Otto; Kai Zhao Journal: Int Forum Allergy Rhinol Date: 2019-05-11 Impact factor: 3.858
Authors: Jennifer Malik; Sachi Dholakia; Barak M Spector; Angela Yang; Dayoung Kim; Nicole A Borchard; Andrew Thamboo; Kai Zhao; Jayakar V Nayak Journal: Int Forum Allergy Rhinol Date: 2020-11-29 Impact factor: 3.858