Details

Autor(en) / Beteiligte

• Maza, Guillermo
• Li, Chengyu
• Krebs, Jillian P.
• Otto, Bradley A.
• Farag, Alexander A.
• Carrau, Ricardo L.
• Zhao, Kai

Titel

Computational fluid dynamics after endoscopic endonasal skull base surgery—possible empty nose syndrome in the context of middle turbinate resection

Ist Teil von

• International forum of allergy & rhinology, 2019-02, Vol.9 (2), p.204-211

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2019

Link zum Volltext

Quelle

Wiley Online Library (Online service)

Beschreibungen/Notizen

• Background Empty nose syndrome (ENS) is a rare and debilitating disease with a controversial definition, etiology, and treatment. One puzzling fact is that patients who undergo an endoscopic endonasal approach (EEA) often have resection of multiple anatomic structures, yet seldom develop ENS. In this pilot study, we analyzed and compared the computational fluid dynamics (CFD) and symptoms among post‐EEA patients, ENS patients, and healthy subjects. Methods Computed tomography scans of 4 post‐EEA patients were collected and analyzed using CFD techniques. Two patients had significant ENS symptoms based on results of the Empty Nose Syndrome 6‐item Questionnaire (score >11), whereas the other 2 were asymptomatic. As a reference, their results were compared with 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. This pattern differed significantly 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 a significantly lower percentage of airflow in the inferior turbinate region (EEA with ENS, 17.74 ± 4.00% vs EEA without ENS, 51.25 ± 3.33% [t test, p < 0.02]; non‐EEA ENS, 25.8 ± 17.6%; healthy subjects, 36.5 ± 15.9%) as well as lower peak wall shear stress (EEA with ENS, 0.30 ± 0.13 Pa vs EEA without ENS, 0.61 ± 0.03 Pa [p = 0.003]; non‐EEA ENS, 0.58 ± 0.24 Pa; healthy subjects, 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 and correlate with aerodynamic changes. The findings open the door for CFD as a potential objective diagnosis tool for ENS.