ObjectiveTo evaluate and compare the efficacy and safety of endoscopic neurectomy versus radiofrequency ablation targeting both the posterior nasal nerve (PNN) and lateral internal nasal branches of the anterior ethmoidal nerve (LINB-AEN) in patients with allergic rhinitis (AR).MethodsIn this prospective randomized controlled trial, adult patients with moderate to severe AR undergoing endoscopic nerve intervention from November 2023 to September 2025 were randomized to receive either neurectomy or ablation. Surgical targets included both PNN and LINB-AEN. Outcomes were assessed at 1, 3, and 6 months postoperatively and included nasal symptom visual analog scale (VAS), total nasal symptom score (TNSS), rhinoconjunctivitis quality of life questionnaire (RQLQ), total nasal resistance (TNR), olfactory function (VAS, QOD-NS, and Sniffin' Sticks), and adverse events.Results61 patients completed follow-up (neurectomy group: n = 30; ablation group: n = 31). Both groups achieved significant symptomatic improvement by 6 months (p < 0.001). The ablation group demonstrated significantly greater improvement in nasal obstruction (p < 0.001) and sneezing (p = 0.008) at 1 month, while the neurectomy group showed earlier improvement in rhinorrhea (p = 0.002). Both procedures improved nasal resistance. Neurectomy provided a faster, sustained nasal resistance improvement (p 3 months = 0.001, p 6 months = 0.003) with superior improvement in odor identification (p < 0.001) and TDI score (p = 0.005). Notably, no serious complications were reported. Additionally, symptoms of nasal dryness improved from baseline in both groups.ConclusionThis is the first randomized controlled study to compare dual-target endoscopic neurectomy and ablation for AR. Both approaches are effective and safe. Ablation offers faster symptom relief, while neurectomy provides superior long-term control of nasal airflow and olfactory function. Individualized surgical planning is recommended based on symptom profile and patient preference.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2500111543Level of Evidence2.

The internal nasal valve (INV) is a key determinant of nasal airflow and is dependent on middle vault integrity. While spreader grafts remain the gold standard for reconstruction, the spreader flap offers a tissue-preserving alternative. This study evaluates outcomes of a modified spreader flap tension suture technique with composite flap elevation in 580 patients, with the hypothesis that this approach yields favorable functional improvements. Retrospective cohort study. Patients who underwent the described procedure were retrospectively identified. Inclusion required a dorsal hump reduction of >3 mm in all cases. Patients were stratified into three groups according to clinical presentation: those undergoing dorsal refinement alone, those with concurrent septal deviation or turbinate hypertrophy, and those with primary INV insufficiency. Prior dorsal rhinoplasty or significant septal deviation were exclusion criteria. Pre- and postoperative (6 months) peak nasal inspiratory flow (PNIF) measurements and visual analog scale (VAS) scores were compared to evaluate objective and subjective functional improvement, respectively. The dorsal refinement group (n = 362) demonstrated stable functional outcomes, with a mean VAS improvement of 2 points. The septal deviation/turbinate hypertrophy group (n = 158) had a mean PNIF increase of 27 L/minute and a 3.5-point VAS improvement, while the INV insufficiency group (n = 60) showed greater gains (PNIF +35 L/minute; VAS +5 points). The modified spreader flap is an effective, cartilage-preserving technique for INV reconstruction, yielding consistent functional and aesthetic outcomes. Further controlled studies are required to assess long-term results.

ObjectiveTo evaluate different virtual-surgical interventions for the correction of unilateral cleft lip nasal deformity (uCLND)-induced nasal airway obstruction (NAO) using computational fluid dynamics (CFD) modeling.DesignPreliminary pilot study involving virtual-surgical interventions based on pre-surgery computed tomography (CT) imaging with CFD analysis.SettingAcademic medical center.Patients, ParticipantsFive subjects aged ≥15 years with uCLND who underwent preoperative CT imaging.InterventionsVirtual-surgical procedures involving varying combinations of inferior turbinate reduction (ITR), anterior (cartilaginous) septoplasty (AS), and posterior (osseous) septoplasty (PS).Main Outcome Measure(s)CFD-identified greatest obstructive site, changes in nasal resistance and airflow distribution calculated from airflow simulations in preoperative and virtual-surgery nasal models, correlation of resistance changes with the minimal clinically important difference (MCID) for patient-reported Nasal Obstruction Symptom Evaluation (NOSE) scores, and evaluation of efficacious virtual procedures balancing surgical complexity.ResultsPreoperatively, all subjects had greater resistance on the cleft side. Isolated septoplasty reduced bilateral resistance by <10%. Cleft-side ITR ± AS and/or PS reduced bilateral resistance by 32% to 54%. Bilateral ITR ± AS/PS achieved the largest improvements, with median reductions of 50% to 66% in bilateral resistance. Non-cleft ITR reduced resistance on the non-cleft side but often worsened airflow asymmetry. The number of procedures resulting in resistance improvements past the MCID threshold varied among subjects.ConclusionsCFD-based virtual-surgical procedures indicated that ITR alone or with septoplasty provided the most effective improvement in nasal resistance and airflow for uCLND. Patient-specific anatomy strongly influenced efficacy, supporting the rationale for the use of computational modeling to assist in personalized surgical planning.

Effect of breathing pattern on nasal airflow, air conditioning, and gas clearance in a patient specific upper airway model.

External nasal valve collapse frequently coexists with nasal tip aesthetic deformities. Conventional correction relies on structural grafting, which may increase operative time, donor-site morbidity, and tip rigidity. We describe a cartilage-preserving, graft-free technique designed to restore external nasal valve competence and refine nasal tip definition. A retrospective clinical series of 30 patients with external nasal valve collapse who underwent graft-free lateral crural rotation between 2022 and 2025 was performed. Patients with a minimum follow-up of 6 months were included. The technique involves mobilization of the lateral crus and its insertion into a subdermal alar pocket without the use of additional cartilage grafts. Outcomes were assessed using physical examination, standardized photographic analysis evaluated by 2 independent observers, and the Rhinoplasty Outcome Evaluation (ROE) questionnaire at 6 months. The technique restored external nasal valve stability on physical examination and improved nasal tip contour on photographic analysis. Observer-based evaluation demonstrated consistent aesthetic improvement. Patients reported improvement in nasal airflow and high satisfaction based on ROE scores. No major complications were observed during the follow-up period. Graft-free lateral crural rotation is a cartilage-preserving technique that may improve external nasal valve support and nasal tip aesthetics while minimizing operative complexity and donor-site morbidity. These preliminary findings suggest favorable functional and aesthetic outcomes; however, further prospective studies with objective functional assessment are required.

The internal nasal valve (INV) is the narrowest segment of the nasal airway and plays a key role in nasal airflow resistance. This study aimed to evaluate the relationship between peak nasal inspiratory flow (PNIF), bilateral INV angles measured on computed tomography (CT), and nasal examination findings in patients presenting with nasal obstruction. This retrospective cross-sectional study included 94 patients who presented with nasal obstruction to the otorhinolaryngology outpatient clinic between January 2024 and September 2025. All patients underwent detailed nasal examination and septal deviation was classified according to the Baumann classification. Bilateral INV angles were measured on coronal paranasal sinus CT images. PNIF values were obtained from medical records. Statistical analyses were performed to assess correlations and group differences. The mean PNIF value was 68.1 ± 24.7L/min, and the mean bilateral INV angle was 11.2 ± 3.2°. A moderate, significant positive correlation was observed between PNIF values and bilateral INV angles (rho = 0.290, p = 0.005). Patients with a bilateral INV angle below 9° had significantly lower PNIF values compared with those with angles ≥ 9° (p = 0.011). No significant differences in PNIF values or INV angles were found among different Baumann septal deviation subtypes. Narrower INV angles are associated with reduced functional nasal airflow as measured by PNIF. Assessment of the INV provides additional functional insight beyond septal deviation classification alone. PNIF represents a practical, noninvasive tool for functional evaluation of nasal obstruction and may support clinical decision-making and surgical planning.

This review examines how chronic rhinitis contributes to sleep-disordered breathing (SDB), shifting the focus from a localized nasal issue to a systemic sleep and respiratory disorder. It highlights inflammatory mechanisms that affect sleep differently from mechanical nasal obstruction, which worsens airway collapsibility. Evidence indicates that chronic rhinitis, regardless of allergy status, is associated with sleep fragmentation and lighter non-REM sleep, with some groups showing reduced REM sleep. Sleep improves, including partial REM restoration, after procedures such as functional endoscopic sinonasal surgery (including turbinoplasty and posterior nasal neurectomy) that reduce nasal resistance. NOSE scale scores, which reflect nasal obstruction severity, correlate with markers of respiratory instability, such as oxygen desaturation and epiglottic collapse, during sleep endoscopy. Excessive daytime sleepiness (ESS) reflects sleep fragmentation rather than specific respiratory events. Rhinitis-related sleep disruption involves oxidative stress and autonomic pathways beyond IgE-mediated inflammation, leading to hypoxia and systemic effects. Nasal airflow and inflammation are key determinants of sleep quality and respiratory stability. Using symptom-based tools with physiological assessments could better identify early and atypical SDB types. Treatments that open nasal passages and reduce inflammation may improve sleep and reduce intermittent hypoxia.

ABSTRACT Evaluating nasal cavity airflow is crucial in both fundamental science and clinical settings. While rhinomanometry (RM) effectively assesses global nasal resistance, developing alternative methods for detailed local structural evaluation remains challenging. Here, we report an approach to measure local pressure at multiple positions in the nasal cavity using 3D‐printed models created based on computed tomography data of five healthy individuals. This approach records multiple pressure differential values at arbitrary positions in the nasal cavity during a breathing‐like inhalation/exhalation cycle. The measured data are unique to the corresponding individuals and correlate well with the RM results from human‐assisted breathing using the 3D‐printed models. Our experimental approach will open up possibilities for a deeper understanding of the relationship between fluid dynamics in the nasal cavity and practical air flow in the nasal cavity.

Nasopharyngeal stenosis is a rare but serious condition that can result from trauma, infection, or postoperative scarring, often leading to significant impairment of nasal breathing and quality of life. Surgical correction may be limited by a high rate of restenosis. This report describes a collaborative surgical-prosthodontic approach for managing recurrent nasopharyngeal stenosis in a 32-year-old male using a custom-fabricated acrylic resin dilator for at-home use. The device was modeled after a previously effective esophageal dilator and modified chairside for passive fit and patient comfort. The patient used the dilator twice daily, reporting improved nasal airflow without complications. Follow-up endoscopy confirmed a stable nasopharyngeal opening and no signs of restenosis. This technique demonstrates the potential role of prosthodontics in the long term, minimally invasive management of airway patency following nasopharyngeal surgery.

The ability of the forebrain to track and integrate respiratory signals, a process known as breathing interoception, is critical for detecting respiratory threats and ensuring survival, yet its neural mechanisms remain largely unknown. Using human intracranial recordings, we identified widespread synchronization between forebrain neural oscillations and breathing rhythms across wakefulness, sleep, and external mechanical ventilation. During wakefulness, localized sites within known interoceptive regions such as insula, somatosensory cortex, anterior cingulate cortex, and amygdala robustly synchronized with breathing, highlighting their critical roles in breathing interoception. During sleep, forebrain synchronization with breathing decreased, while persisting in the amygdala and hippocampus, which may support vigilance and memory consolidation. In contrast to rodents, nasal airflow was not required for this synchronization, implicating multiple afferent pathways in respiratory interoception and possible unique evolutionary changes in humans. When breathing was driven by an external mechanical ventilator, the imposed breathing rhythm directly entrained forebrain activity, indicating a causal link. Notably, ventilator-driven slow, deep breathing entrained more forebrain sites, suggesting a potential mechanism through which breath-based practices might influence emotion and cognition. Together, these findings redefine breathing interoception as a pervasive influence within the forebrain, with implications for understanding disorders of respiratory awareness, emotional regulation, and cognitive health.

Full-thickness nasal defects of the tip, soft triangle, and ala are commonly reconstructed using a paramedian forehead flap with cartilage grafts or an epithesis. However, these approaches may be associated with donor-site morbidity and psychological burden. Cartilage grafts are generally considered necessary to prevent nostril collapse during inspiration. The aim of this study was to assess whether cartilage grafting is required to prevent nasal collapse and to evaluate patient satisfaction, complications, and functional and aesthetic outcomes. This case series analysed postoperative outcomes in 10patients following two-stage folded paramedian forehead flap reconstruction without cartilage grafts. Median follow-up was 14months. Outcomes included patient satisfaction as well as functional and aesthetic results. All patients reported being satisfied or very satisfied with their long-term postoperative outcomes. Nasal airflow on the reconstructed side was preserved without impairment. No cases of nostril collapse during inhalation were observed. Additionally, no hypertrophic scarring or tissue necrosis occurred. Two-stage reconstruction of full-thickness nasal defects using a folded paramedian forehead flap without cartilage grafts provides good functional and aesthetic outcomes with high patient satisfaction. In most cases, additional cartilage grafting appears unnecessary.

Impact of Combined Holmium:YAG Laser-Assisted Inferior Turbinate Reduction and Adenoidectomy on Pediatric Nasal Obstruction: A Prospective Study.

Chronic rhinitis (CR) is inflammation of the nasal mucosa, causing a multitude of symptoms. Temperature-controlled radiofrequency neurolysis (RFN) of the posterior nasal nerve (PNN) is a treatment for CR. In allergic rhinitis (AR), Type 2 cytokines are drivers of symptom severity. This study explores whether RFN's symptomatic improvements are linked to changes in nasal airflow and local cytokine levels. This prospective, single-arm study was conducted at the Texas Sinus Institute at The University of Texas Health Science Center at Houston. Patients with ≥6 months of CR symptoms, a reflective total nasal symptom score (rTNSS) ≥6, and refractory to medical management were included. Follow-ups occurred at 4 and 12 weeks, with the primary endpoint at 12 weeks. Symptom improvement, peak nasal inspiratory flow (PNIF) and cytokine changes were assessed. Seventeen patients were enrolled with 15 patients undergoing the treatment. The procedure was well tolerated with no major adverse events. The rTNSS improved from a median of 7.5 to 4 at 12 weeks (P < .01). Median NOSE scores improved from 52.5 to 17.5 at week 12 (P < .05). Minimal clinically important differences (MCID) were achieved by 67% of patients for rTNSS and 50% for NOSE. There were no significant changes in PNIF. Patient-level change in IL-10 was significantly associated with improvement in NOSE score (r = -.70, P = .011). RFN of the PNN is a safe, effective in-office treatment for CR. While PNIF and group-level cytokines were not consistent indicators of improvement, the correlation between IL-10 and symptom relief suggests a potential link between neural ablation and the local mucosal microenvironment. This investigation shows the feasibility of cytokine monitoring to further investigate the mechanisms of rhinitis treatment.

Velopharyngeal incompetence may contribute to speech difficulties in Parkinson's disease (PD) but has been minimally studied. This study investigated the acoustic and aerodynamic characteristics of nasal airflow in people with and without PD. Twenty adults diagnosed with idiopathic PD and 20 age- and sex-matched controls produced consonant-vowel speech stimuli while wearing a nasal airflow mask and oral microphone. Mean nasal airflow was measured during the 25-ms period immediately preceding consonant release ("burst airflow") and over the central 100 ms of each vowel ("vowel airflow"). Vocal intensity (dB SPL) was also measured over the center of each vowel. The PD group exhibited significantly higher burst airflow than the control group (7.7 vs. 1.9 cc/s), though vowel airflow did not differ significantly between groups. Vocal intensity was positively associated with burst and vowel nasal airflow only in the PD group, despite comparable mean intensity levels between groups. Within the PD group, disease duration and speech-specific motor scores were significantly correlated with burst airflow, and voice-related quality of life was correlated with vowel airflow. Velopharyngeal dysfunction in PD was more pronounced during rapid motor sequences (stop consonant bursts) than vowel production and showed dynamic motor deterioration under increasing vocal intensities. The intensity-airflow relationship observed in PD suggests compromised velopharyngeal closure during higher vocal demands. Measures of velopharyngeal dysfunction may be useful markers of axial motor symptom severity, which has a large impact on quality of life and prognosis in people with PD.

HighlightsPublic health relevance—How does this work relate to a public health issue?Persistent allergic rhinitis significantly impacts daily productivity and quality of life, necessitating accessible and scalable management strategies.This study addresses the need for non-pharmacological adjuncts to manage chronic respiratory symptoms and airway inflammation in the adult population.Public health significance—Why is this work of significance to public health?An eight-week moderate-intensity aerobic exercise program substantially improves both subjective symptom severity and objective physiological markers, including Peak Nasal Inspiratory Flow (PNIF) and lung function (FEV1, FVC).The intervention demonstrates a significant reduction in eosinophilic airway inflammation (FeNO), supporting the “one airway, one disease” framework in public health management.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?Structured aerobic exercise is a safe, low-cost, and feasible “physical activity prescription” that can be integrated into community-based care and routine clinical practice.These findings empower patients toward self-management and provide an evidence-based approach to mitigate the socioeconomic burden of chronic allergic conditions.Allergic Rhinitis (AR) is an IgE-mediated inflammatory disorder that impairs quality of life and systemic function. Following the ‘one airway, one disease’ paradigm, AR-related inflammation often extends to the lower respiratory tract. This randomized controlled trial investigated the effects of an 8-week moderate-intensity aerobic exercise (MOA) program on clinical symptoms, nasal airflow, airway inflammation, pulmonary function, and cardiorespiratory parameters in young adults with physician-confirmed persistent AR. To isolate the exercise effects, all participants discontinued antihistamines, corticosteroids, and leukotriene antagonists before and during the study period. Eighteen participants were allocated to either the MOA group (n = 9), which performed treadmill walking or jogging at 50–60% heart rate reserve three times per week for eight weeks, or a control group (CON, n = 9) that maintained usual daily activities. Clinical symptoms, peak nasal inspiratory flow, fractional exhaled nitric oxide, pulmonary function, heart rate, blood pressure, aerobic fitness, and perceived exertion were assessed at baseline, week 4, and week 8 using standardized procedures. Compared with baseline and the CON group, the exercise intervention resulted in significant reductions in nasal congestion, itching, sneezing, and rhinorrhea, accompanied by increased nasal airflow and reduced airway inflammation. Pulmonary function indices and cardiorespiratory parameters also improved following training. These findings suggest that moderate-intensity aerobic exercise may offer a valuable non-pharmacological approach to support conventional care, potentially enhancing respiratory and physiological outcomes in young adults with persistent AR.

This review explores recent evidence on the long-term effects of pediatric nasal and maxillofacial surgery on midfacial growth, emphasizing the impact of modern techniques, timing and cephalometric outcome measures. Systematic reviews confirm that conservative pediatric septal surgery does not seem to compromise midfacial growth when cartilage-preserving techniques are used. There is a trend towards inclusion of septoplasty at time of primary cleft lip repair rather than deferring, with improved nasal airflow and unaffected midfacial growth. Early cleft palate repair appears to be safe with respect to maxillary retrusion. Standardized cephalometric reporting remains lacking. Contemporary evidence supports the safety of growth-preserving pediatric midfacial surgery, with early intervention offering functional and neurocognitive benefit, though standardized long-term outcome data remains an area for further research.

Empty Nose Syndrome (ENS) is a rare and paradoxical complication often associated with aggressive turbinate reductions. Previous computational fluid dynamic (CFD) modeling has indicated that distorted nasal airflow patterns could contribute to ENS. However, no data have shown that aggressive turbinate reductions consistently lead to ENS. Retrospective case series. Tertiary. We retrospectively recruited 6 nasal obstruction patients who underwent turbinate reduction surgery, and performed total inferior and middle turbinectomies on all patients using a published virtual surgical simulator. We compared the CFD modeling results to that of patients' presurgery and postsurgery and published 27 ENS patients. As expected, the virtual turbinectomy significantly expanded nasal airway cross-sectional area, more than that of actual surgery (inferior: 0.9 ± 0.4 to1.8 ± 0.3 cm2, middle: 0.6 ± 0.3 to 1.0 ± 0.3 cm2, all P < .01); however, it does not create the same distorted nasal airflow patterns as seen in ENS patients, with no significant difference in nasal resistance after actual surgery (0.12 ± 0.04 Pa/mL*s) versus virtual surgery (0.10 ± 0.03 Pa/mL*s) nor ENS (0.11 ± 0.04 Pa/mL*s, all P > .05). However, all had significantly higher inferior wall shear force (WSF) distribution, an important indicator of air/mucosa stimulation, than that of ENS patients (baseline 54.0 ± 11.9%, surgery: 51.5 ± 15.1%; virtual: 46.5 ± 11.5%, P > .05; ENS: 32.2% ± 12.5%, P < .001). The opposite was seen for the middle turbinate region-WSF among all actual or virtual surgeries conditions was significantly lower than that of the ENS group (baseline: 36.1 ± 11.0%; virtual: 30.2 ± 13.1%; ENS: 43.8 ± 10.1%; all P ≤ .05). ENS cannot be solely attributed to aggressive turbinate reduction surgeries with various factors potentially playing a role.

Associations of miniscrew length with long-term skeletal, dentoalveolar, and nasal airflow changes after miniscrew-assisted rapid palatal expansion: A retrospective cohort study.

This study focuses on the issue of maxillary bone developmental abnormalities in cleft palate patients, breaking through the traditional cognitive limitation of attributing the condition solely to surgical scar effects. Clinical observations revealed that maxillary retrusion also exists in unoperated cleft palate patients, leading to the hypothesis that nasal cavity pressure may have an influence on maxillary bone development in these patients. Using finite element analysis techniques, a 3-dimensional model of the soft palate-trachea region was constructed to simulate the pressure changes on the nasal surface of the maxillary bone under different velopharyngeal closure states (velopharyngeal insufficiency, excessive velopharyngeal closure, and normal state). The results showed that the size of the velopharyngeal gap is closely related to the airflow pressure stimulation received by the maxillary bone. The larger the velopharyngeal distance, the stronger the negative pressure on the surface of the maxillary bone, which may inhibit its development; the smaller the velopharyngeal distance, the weaker the negative pressure, which helps to reduce the inhibitory effect. This study provides a new perspective for understanding the mechanism of maxillary bone development in cleft palate patients and offers important guidance for optimizing cleft palate treatment strategies.

Respiratory-swallowing coordination is critical for safe swallowing. Respiratory phase patterns, indicating the direction of respiration bracketing swallowing, appear minimally altered when oral airflow is measured alongside nasal airflow. Measures from an oronasal facemask also demonstrate broader features of swallowing non-respiratory flow (SNRF) associated with the respiratory-swallowing pause than previously reported. Additionally, nasal and oronasal flow estimates show variability in within-individual respiratory phase patterning. In this study, an oronasal facemask and separate nasal-only mask were used to assess healthy individuals, exploring how instrumentation influences respiratory phase pattern estimates across swallowing tasks. Characteristics of SNRF and variability of respiratory phase patterns were also investigated. Adding oral flow to nasal flow appeared to reduce estimated exhale-swallow-exhale patterning by 13% and increased the estimated frequency of alternative patterns, although this may include some genuine variance between the datasets due to asynchronous data acquisition from each mask. SNRF occurred in 87-97% of swallows, with inward and outward flow occurring at the onset and offset of the respiratory-swallowing pause. Test-retest reliability of respiratory phase patterns within individuals ranged from κ =0.4 - 0.54, with ≥2 patterns observed across four trials >40% of the time. Findings suggest that adding oral to nasal flow alters estimates of respiratory phase patterns, particularly during ingestive swallowing tasks. SNRF is observed more frequently when measured through a closed system, presenting as inwardly- or outwardly-directed airflow at the beginning or end of the respiratory-swallowing pause. Finally, there appears to be considerable variability in respiratory phase patterning across trials of the same swallowing condition.