Does Perception of Nasal Patency Correlate with Mucosal Cooling after Surgery for Nasal Obstruction?

Abstract

Objectives: 1) Quantify heat fluxes (ie, mucosal cooling) spatially in the nasal passages of nasal airway obstruction (NAO) patients before and after surgery using computational fluid dynamics (CFD). 2) Develop methods to correlate heat fluxes with patient-reported symptoms, as measured by the nasal obstruction symptom evaluation (NOSE) and the visual analog score (VAS). Methods: Computed tomography (CT) scans of 10 patients were obtained before and after surgery to relieve NAO. Three-dimensional models of each patient’s nasal anatomy were used to run steady-state CFD simulations of airflow and heat transfer during inspiration. The importance of anatomic location for perception of nasal patency was evaluated by comparing heat fluxes in the nasal vestibule vs. the entire nasal cavity, and by evaluating the percentage of nasal mucosa exposed to heat fluxes greater than 500 W/m2. Results: Post-operatively, heat fluxes were statistically higher on the pre-operative most obstructed side, for the nasal vestibule alone and the entire nasal cavity (p values < 0.01). A larger area of nasal mucosa was exposed to heat fluxes > 500 W/m2 after surgery than before. The best correlation between subjective and objective measures of nasal patency was obtained for NOSE against heat flux in the entire most obstructed nasal cavity (r = −0.81). Conclusions: A significant increase in heat fluxes (ie, mucosal cooling) correlates well with patients’ perception of better nasal patency after NAO surgery. CFD-derived heat fluxes may prove to be a valuable predictor of success in NAO surgery.