Physical stresses at the air-wall interface of the human nasal cavity during breathing

Computational analysis of nasal airflow and its alteration by a nasal dilator

Nasal airflow obstruction correlates with several ailments, such as higher patency, increased friction at the mucosal wall or the so-called Little's area, improper air conditioning, and snoring. Nasal dilators are frequently employed, mainly due to their ease of access and use, combined with their non-permanent and non-surgical nature. Their overall efficacy, however, has not been clearly demonstrated so far, with some studies reporting conflicting outcomes, mainly because being based on subjective evaluations. This study employs Computational Fluid Dynamics simulations to analyze the flow inside a real nose, performs an objective assessment of a nasal dilator's effect in terms of airflow and air conditioning, reporting flow paths, friction levels, heat and water fluxes and detailed temperature and humidity distributions. Coincidentally, the studied nose presents a septal deviation, with one nostril being wider than the other. The tubes of the dilator used in both nostrils are identical, as with any standard commercial dilator. Consequently, the dilator widens one nostril, as intended, but results in an obstruction in the other. This allows simultaneously addressing two situations, the nominal function of the dilator, as well as an off-design case. Results indicate a 24 % increase in nasal patency in the design situation. The effect, however, is limited, as quantified by appropriate measures, such as the flow-generated friction at the nose surfaces and the temperature fluxes. Hence, the effect of such a dilator in nominal conditions is perhaps not as large as might be hoped. In the off-design situation, nasal resistance increases by 62 %, an undesirable effect, illustrating the consequences of using an inappropriate dilator.

Nasal Breathing Assessment Using Computational Fluid Dynamics: An Update from the Rhinologic Perspective

An objective assessment of nasal breathing is currently insufficiently achievable. The application of computational fluid dynamics for this purpose is increasingly gaining attention. However, the suggested specific frameworks can differ considerably. To the best of our knowledge, there is not yet a widely accepted clinical usage of computational fluid dynamics. In this article, selected aspects are addressed that might be crucial for future development and possible implementation of computational fluid dynamics in rhinology.

Overview of Nasal Airway and Nasal Breathing Evaluation

Several methods are available for evaluating nasal breathing and nasal airflow, as this evaluation may be made from several different perspectives.Physiologic methods for nasal airway evaluation directly measure nasal airflow or nasal airway resistance, while anatomical methods measure nasal airway dimensions. Subjective methods evaluate nasal breathing through several validated patient-reported scales assessing nasal breathing. Computational fluid dynamics evaluates nasal airflow through the analysis of several physics' variables of the nasal airway.Being familiar to these methods is of utmost importance for the nasal surgeon to be able to understand data provided by the different methods and to be able to choose the combination of evaluation methods that will provide the information most relevant to each clinical situation.

The Path from Nasal Tissue to Nasal Mucosa on Chip: Part 2-Advanced Microfluidic Nasal In Vitro Model for Drug Absorption Testing

The nasal mucosa, being accessible and highly vascularized, opens up new opportunities for the systemic administration of drugs. However, there are several protective functions like the mucociliary clearance, a physiological barrier which represents is a difficult obstacle for drug candidates to overcome. For this reason, effective testing procedures are required in the preclinical phase of pharmaceutical development. Based on a recently reported immortalized porcine nasal epithelial cell line, we developed a test platform based on a tissue-compatible microfluidic chip. In this study, a biomimetic glass chip, which was equipped with a controlled bidirectional airflow to induce a physiologically relevant wall shear stress on the epithelial cell layer, was microfabricated. By developing a membrane transfer technique, the epithelial cell layer could be pre-cultivated in a static holder prior to cultivation in a microfluidic environment. The dynamic cultivation within the chip showed a homogenous distribution of the mucus film on top of the cell layer and a significant increase in cilia formation compared to the static cultivation condition. In addition, the recording of the ciliary transport mechanism by microparticle image velocimetry was successful. Using FITC-dextran 4000 as an example, it was shown that this nasal mucosa on a chip is suitable for permeation studies. The obtained permeation coefficient was in the range of values determined by means of other established in vitro and in vivo models. This novel nasal mucosa on chip could, in future, be automated and used as a substitute for animal testing.

Numerical modelling of micron particle inhalation in a realistic nasal airway with pediatric adenoid hypertrophy: A virtual comparison between pre- and postoperative models

Adenoid hypertrophy (AH) is an obstructive condition due to enlarged adenoids, causing mouth breathing, nasal blockage, snoring and/or restless sleep. While reliable diagnostic techniques, such as lateral soft tissue x-ray imaging or flexible nasopharyngoscopy, have been widely adopted in general practice, the actual impact of airway obstruction on nasal airflow and inhalation exposure to drug aerosols remains largely unknown. In this study, the effects of adenoid hypertrophy on airflow and micron particle inhalation exposure characteristics were analysed by virtually comparing pre- and postoperative models based on a realistic 3-year-old nasal airway with AH. More specifically, detailed comparison focused on anatomical shape variations, overall airflow and olfactory ventilation, associated particle deposition in overall and local regions were conducted. Our results indicate that the enlarged adenoid tissue can significantly alter the airflow fields. By virtually removing the enlarged tissue and restoring the airway, peak velocity and wall shear stress were restored, and olfactory ventilation was considerably improved (with a 16∼63% improvement in terms of local ventilation speed). Furthermore, particle deposition results revealed that nasal airway with AH exhibits higher particle filtration tendency with densely packed deposition hot spots being observed along the floor region and enlarged adenoid tissue area. While for the postoperative model, the deposition curve was shifted to the right. The local deposition efficiency results demonstrated that more particles with larger inertia can be delivered to the targeted affected area following Adenoidectomy (Adenoid Removal). Research findings are expected to provide scientific evidence for adenoidectomy planning and aerosol therapy following Adenoidectomy, which can substantially improve present clinical treatment outcomes.

Critical design parameters to develop biomimetic organ-on-a-chip models for the evaluation of the safety and efficacy of nanoparticles

INTRODUCTION

Organ-on-a-chip (OOC) models are based on microfluidics and can recapitulate the healthy and diseased microstructure of organs¹ and tissues and the dynamic microenvironment inside the human body. However, the use of OOC models to evaluate the safety and efficacy of nanoparticles (NPs) is still in the early stages.

AREAS COVERED

The different design parameters of the microfluidic chip and the mechanical forces generated by fluid flow play a pivotal role in simulating the human environment. This review discusses the role of different key parameters on the performance of OOC models. These include the flow pattern, flow rate, shear stress (magnitude, rate, and distribution), viscosity of the media, and the microchannel dimensions and shape. We also discuss how the shear stress and other mechanical forces affect the transport of NPs across biological barriers, cell uptake, and their biocompatibility.

EXPERT OPINION

We describe several good practices and design parameters to consider for future OOC research. We submit that following these recommendations will help realize the full potential of the OOC models in the preclinical evaluation of novel therapies, including NPs.

Mental health burden of empty nose syndrome compared to chronic rhinosinusitis and chronic rhinitis

BACKGROUND

Empty nose syndrome (ENS) is characterized by the paradoxical perception of nasal obstruction despite patent sinonasal anatomy after surgery. We investigated the relationship between ENS, and anxiety, depression, obsessive-compulsive disorder, and somatic symptom disorder (SSD) compared to individuals with chronic rhinitis (CR) and chronic rhinosinusitis (CRS).

METHODS

This cross-sectional survey study compared ENS and CR and CRS patients. A total of 116 patients participated: 58 ENS patients from digital support groups, and 58 CRS and CR patients from tertiary rhinology clinics. Study participants completed four validated surveys: (1) Empty Nose Syndrome 6-Item Questionnaire, (2) Rhinosinusitis Disability Index (RSDI), (3) Obsessive Compulsive Inventory - Revised (OCI-R), and (4) PRIME MD Patient Health Questionnaire (PHQ).

RESULTS

ENS patients exhibited a mean RSDI of 78.6, 95% confidence interval [CI] 72.8-84.5, compared to 25.2, 95% CI 18.6-31.8 for CRS/CR patients (p < 0.0001). This difference was seen across all subdomains. Using the PHQ, 53% of ENS patients met diagnostic thresholds for SSD compared to 14% of CRS patients (p < 0.0001). In relation to obsessive compulsive disorder (OCD), 18.37% of ENS patients compared to 8.62% of CRS/CR patients scored above the diagnostic threshold (>21) on the OCI-R questionnaire (p = 0.159).

CONCLUSION

ENS patients had diminished sinonasal quality of life and a higher prevalence of comorbid anxiety and depression, compared to CR and CRS. ENS patients were more likely to exceed thresholds for OCD and SSD compared to controls. Future studies are needed to assess the role of SSD in ENS to help optimize treatment for these complex patients.

3D printed transwell-integrated nose-on-chip model to evaluate effects of air flow-induced mechanical stresses on mucous secretion

While there are many chip models that simulate the air-tissue interface of the respiratory system, only a few represent the upper respiratory system. These chips are restricted to unidirectional flow patterns that are not comparable to the highly dynamic and variable flow patterns found in the native nasal cavity. Here we describe the development of a tunable nose-on-chip device that mimics the air-mucosa interface and is coupled to an air delivery system that simulates natural breathing patterns through the generation of bi-directional air flow. Additionally, we employ computational modeling to demonstrate how the device design can be tuned to replicate desired mechanical characteristics within specific regions of the human nasal cavity. We also demonstrate how to culture human nasal epithelial cell line RPMI 2650 within the lab-on-chip (LOC) device. Lastly, Alcian Blue histological staining was performed to label mucin proteins, which play important roles in mucous secretion. Our results revealed that dynamic flow conditions can increase mucous secretion for RPMI 2650 cells, when compared to no flow, or stationary, conditions.

Septal deviation in the nose of the longest faced crocodylian: A description of nasal anatomy and airflow in the Indian gharial (Gavialis gangeticus) with comments on acoustics

The remarkably thin rostrum in the Indian gharial (Gavialis gangeticus) imparts challenges to nasal physiology. Competition for space in the slim jaws necessitates a thin nasal septum, leaving this taxon susceptible to nasal passage abnormalities such as septal deviation. Here we describe the nasal anatomy of gharials based on multiple individuals including one that showcases an extreme instance of nasal septum deviation. We found that gharials have both confluent nostrils and choanae, which may be important for their unique nasal acoustics. The deviated nasal septum in the female showed distinct waviness that affected the nasal passages by alternately compressing them. We performed a computational fluid dynamic analysis on the nasal passages to visualize the effects of septal deviation on airflow. Our analysis found the deviated septum increased nasal resistance and wall shear stress during respiration, resulting in unequal distribution of the air field between both sides of the nasal passage. Our findings indicate that gharials-and potentially other longirostrine crocodylians-may be particularly susceptible to septal deviations. Lastly, we observed pterygoid bullae to be present in both sexes, though their morphology differed. Airflow in the male pterygoid bullae produced a Bernoulli effect which may be responsible for the unique "pop" sounds recorded in this species.

An integrative review on the uses of plant-derived bioactives formulated in conventional and innovative dosage forms for the local treatment of damaged nasal cavity

Plants and their derivates have been used as medicines for centuries and today is being re-discovered their usefulness for the human health. The therapeutic properties of phytochemicals are re-evaluated under the light of medical and pharmacological research, pushed by a constantly growing market demand, where consumers trust more natural products than synthetic drugs. New studies are enlightening the effectiveness of phytochemicals against a wide range of ailments, nevertheless very few evaluate the efficacy of topical formulations based on natural bioactive molecules in the treatment of nasal mucosal diseases. This review aims at exploring this little covered topic. An overview on the properties and functionality of the nasal mucosa and the different diseases affecting it has been provided. We summarized various nasal dosage forms containing natural bioactive and explored how innovative delivery systems loading phytochemicals can improve the treatment results. Finally, the potential use of novel nanocarriers for the treatment of nasal ailments has been covered as well.

Development of Microfluidic, Serum-Free Bronchial Epithelial Cells-on-a-Chip to Facilitate a More Realistic In vitro Testing of Nanoplastics

Most cell culture models are static, but the cellular microenvironment in the body is dynamic. Here, we established a microfluidic-based in vitro model of human bronchial epithelial cells in which cells are stationary, but nutrient supply is dynamic, and we used this system to evaluate cellular uptake of nanoparticles. The cells were maintained in fetal calf serum-free and bovine pituitary extract-free cell culture medium. BEAS-2B, an immortalized, non-tumorigenic human cell line, was used as a model and the cells were grown in a chip within a microfluidic device and were briefly infused with amorphous silica (SiO2) nanoparticles or polystyrene (PS) nanoparticles of similar primary sizes but with different densities. For comparison, tests were also performed using static, multi-well cultures. Cellular uptake of the fluorescently labeled particles was investigated by flow cytometry and confocal microscopy. Exposure under dynamic culture conditions resulted in higher cellular uptake of the PS nanoparticles when compared to static conditions, while uptake of SiO2 nanoparticles was similar in both settings. The present study has shown that it is feasible to grow human lung cells under completely animal-free conditions using a microfluidic-based device, and we have also found that cellular uptake of PS nanoparticles aka nanoplastics is highly dependent on culture conditions. Hence, traditional cell cultures may not accurately reflect the uptake of low-density particles, potentially leading to an underestimation of their cellular impact.

Nasal airflow of patient with septal deviation and allergy rhinitis

A numerical simulation of a patient’s nasal airflow was developed via computational fluid dynamics. Accordingly, computerized tomography scans of a patient with septal deviation and allergic rhinitis were obtained. The three-dimensional (3D) nasal model was designed using InVesalius 3.0, which was then imported to (computer aided 3D interactive application) CATIA V5 for modification, and finally to analysis system (ANSYS) flow oriented logistics upgrade for enterprise networks (FLUENT) to obtain the numerical solution. The velocity contours of the cross-sectional area were analyzed on four main surfaces: the vestibule, nasal valve, middle turbinate, and nasopharynx. The pressure and velocity characteristics were assessed at both laminar and turbulent mass flow rates for both the standardized and the patient’s model nasal cavity. The developed model of the patient is approximately half the size of the standardized model; hence, its velocity was approximately two times more than that of the standardized model.

An Overview of Computational Fluid Dynamics Preoperative Analysis of the Nasal Airway

Evaluation of the nasal airway is crucial for every patient with symptoms of nasal obstruction as well as for every patient with other nasal symptoms. This assessment of the nasal airway comprises clinical examination together with imaging studies, with the correlation between findings of this evaluation and symptoms reported by the patient being based on the experience of the surgeon. Measuring nasal airway resistance or nasal airflow can provide additional data regarding the nasal airway, but the benefit of these objective measurements is limited due to their lack of correlation with patient-reported evaluation of nasal breathing. Computational fluid dynamics (CFD) has emerged as a valuable tool to assess the nasal airway, as it provides objective measurements that correlate with patient-reported evaluation of nasal breathing. CFD is able to evaluate nasal airflow and measure variables such as heat transfer or nasal wall shear stress, which seem to reflect the activity of the nasal trigeminal sensitive endings that provide sensation of nasal breathing. Furthermore, CFD has the unique capacity of making airway analysis of virtual surgery, predicting airflow changes after trial virtual modifications of the nasal airway. Thereby, CFD can assist the surgeon in deciding surgery and selecting the surgical techniques that better address the features of each specific nose. CFD has thus become a trend in nasal airflow assessment, providing reliable results that have been validated for analyzing airflow in the human nasal cavity. All these features make CFD analysis a mainstay in the armamentarium of the nasal surgeon. CFD analysis may become the gold standard for preoperative assessment of the nasal airway.

Investigation of airflow at different activity conditions in a realistic model of human upper respiratory tract

In the present study, the turbulent flows inside a realistic model of the upper respiratory tract were investigated numerically and experimentally. The airway model included the geometrical details of the oral cavity to the end of the trachea that was based on a series of CT-scan images. The topological data of the respiratory tract were used for generating the computational model as well as the 3D-printed model that was used in the experimental pressure drop measurement. Different airflow rates of 30, 45, and 60 L/min, which correspond to the light, semi-light, and heavy activity breathing conditions, were investigated numerically using turbulence and transition models, as well as experimentally. Simulation results for airflow properties, including velocity vectors, pressure drops, streamlines, eddy viscosity, and turbulent kinetic energy contours in the oral-trachea airway model, were presented. The simulated pressure drop was compared with the experimental data, and reasonable agreement was found. The obtained results showed that the maximum pressure drop occurs in the narrowest part of the larynx region. A comparison between the numerical results and experimental data showed that the transition (γ-Reθ) SST model predicts higher pressure losses, especially at higher breathing rates. Formations of the secondary flows in the oropharynx and trachea regions were also observed. In addition, the simulation results showed that in the trachea region, the secondary flow structures dissipated faster for the flow rate of 60 L/min compared to the lower breathing rates of 30 and 45 L/min.

Tissue engineered endometrial barrier exposed to peristaltic flow shear stresses

Cyclic myometrial contractions of the non-pregnant uterus induce intra-uterine peristaltic flows, which have important roles in transport of sperm and embryos during early stages of reproduction. Hyperperistalsis in young females may lead to migration of endometrial cells and development of adenomyosis or endometriosis. We conducted an in vitro study of the biological response of a tissue engineered endometrial barrier exposed to peristaltic wall shear stresses (PWSSs). The endometrial barrier model was co-cultured of endometrial epithelial cells on top of myometrial smooth muscle cells (MSMCs) in custom-designed wells that can be disassembled for mechanobiology experiments. A new experimental setup was developed for exposing the uterine wall in vitro model to PWSSs that mimic the in vivo intra-uterine environment. Peristaltic flow was induced by moving a belt with bulges to deform the elastic cover of a fluid filled chamber that held the uterine wall model at the bottom. The in vitro biological model was exposed to peristaltic flows for 60 and 120 min and then stained for immunofluorescence studies of alternations in the cytoskeleton. Quantification of the F-actin mass in both layers revealed a significant increase with the length of exposure to PWSSs. Moreover, the inner layer of MSMCs that were not in direct contact with the fluid also responded with an increase in the F-actin mass. This new experimental approach can be expanded to in vitro studies of multiple structural changes and genetic expressions, while the tissue engineered uterine wall models are tested under conditions that mimic the in vivo physiological environment.

CFD analysis of the flow structure in a monkey upper airway validated by PIV experiments

Inhalation exposure to airborne contaminants has adverse effects on humans; however, related research is typically conducted using in vivo/in vitro tests on animals. Extrapolating the test results is complicated by anatomical and physiological differences between animals and humans and a lack of understanding of the transport mechanism inside their respective respiratory tracts. This study determined the detailed air-flow structure in the upper airway of a monkey. A steady computational fluid dynamics simulation, which was validated by previous particle image velocimetry measurements, was adopted for flow rates of 4 L/min and 10 L/min to analyze the flow structure from the nasal/oral cavities to the trachea region in a monkey airway model. The low Reynolds number type k-ε model provided a reasonably accurate prediction of the airflow in a monkey upper airway. Furthermore, it was confirmed that large velocity gradients were generated in the nasal vestibule and larynx regions, as well as increased turbulent air kinetic energy and wall sheer stress.

Impact of endoscopic craniofacial resection on simulated nasal airflow and heat transport

BACKGROUND

Endoscopic craniofacial resections (CFR) are performed for extensive anterior skull base lesions. This surgery involves removal of multiple intranasal structures, potentially leading to empty nose syndrome (ENS). However, many patients remain asymptomatic postoperatively. Our objective was to analyze the impact of CFR on nasal physiology and airflow using computational fluid dynamics (CFD). This is the first CFD analysis of post-CFR patients.

METHODS

Three-dimensional sinonasal models were constructed from 3 postoperative images using Mimics^TM . Hybrid computational meshes were created. Steady inspiratory airflow and heat transport were simulated at patient-specific flow rates using shear stress transport k-omega turbulent flow modeling in Fluent^TM . Simulated average heat flux (HF) and surface area where HF exceeded 50 W/m² (SAHF50) were compared with laminar simulations in 9 radiographically normal adults.

RESULTS

Three adults underwent CFR without developing ENS. Average HF (W/m² ) were 132.70, 134.84, and 142.60 in the CFR group, ranging from 156.24 to 234.95 in the nonoperative cohort. SAHF50 (m² ) values were 0.0087, 0.0120, and 0.0110 in the CFR group, ranging from 0.0082 to 0.0114 in the radiographically normal cohort. SAHF50 was distributed throughout the CFR cavities, with increased HF at the roof and walls compared with the nonoperative cohort.

CONCLUSION

Average HF was low in the CFR group compared with the nonoperative group. However, absence of ENS in most CFR patients may be due to large stimulated mucosal surface area, commensurate with the nonoperative cohort. Diffuse distribution of stimulated area may result from turbulent mixing after CFR. To better understand heat transport post-CFR, a larger cohort is necessary.

Sensitivity of nasal airflow variables computed via computational fluid dynamics to the computed tomography segmentation threshold

Computational fluid dynamics (CFD) allows quantitative assessment of transport phenomena in the human nasal cavity, including heat exchange, moisture transport, odorant uptake in the olfactory cleft, and regional delivery of pharmaceutical aerosols. The first step when applying CFD to investigate nasal airflow is to create a 3-dimensional reconstruction of the nasal anatomy from computed tomography (CT) scans or magnetic resonance images (MRI). However, a method to identify the exact location of the air-tissue boundary from CT scans or MRI is currently lacking. This introduces some uncertainty in the nasal cavity geometry. The radiodensity threshold for segmentation of the nasal airways has received little attention in the CFD literature. The goal of this study is to quantify how uncertainty in the segmentation threshold impacts CFD simulations of transport phenomena in the human nasal cavity. Three patients with nasal airway obstruction were included in the analysis. Pre-surgery CT scans were obtained after mucosal decongestion with oxymetazoline. For each patient, the nasal anatomy was reconstructed using three different thresholds in Hounsfield units (-800HU, -550HU, and -300HU). Our results demonstrate that some CFD variables (pressure drop, flowrate, airflow resistance) and anatomic variables (airspace cross-sectional area and volume) are strongly dependent on the segmentation threshold, while other CFD variables (intranasal flow distribution, surface area) are less sensitive to the segmentation threshold. These findings suggest that identification of an optimal threshold for segmentation of the nasal airway from CT scans will be important for good agreement between in vivo measurements and patient-specific CFD simulations of transport phenomena in the nasal cavity, particularly for processes sensitive to the transnasal pressure drop. We recommend that future CFD studies should always report the segmentation threshold used to reconstruct the nasal anatomy.

Modelling mucosal surface roughness in the human velopharynx: a computational fluid dynamics study of healthy and obstructive sleep apnea airways

We previously published a unique methodology for quantifying human velopharyngeal mucosal surface topography and found increased mucosal surface roughness in obstructive sleep apnea (OSA) patients. In fluid mechanics, surface roughness is associated with increased frictional pressure losses and resistance. This study used computational fluid dynamics (CFD) to analyse the mechanistic effect of different levels of mucosal surface roughness on velopharyngeal airflow.

METHODS

Reconstructed velopharyngeal models from OSA and Control subjects were modified, giving each model three levels of roughness, quantified by the curvature based surface roughness index (CBSRI_0.6; range 24.8-68.6mm^-1). CFD using the k-ω shear stress transport (SST) turbulence model was performed (unidirectional, inspiratory, steady state, 15l/min volumetric flow rate), and the effects of roughness on flow velocity, intraluminal pressure, wall shear stress and velopharyngeal resistance (R_v) were examined.

RESULTS

Across all models, increasing roughness increased maximum flow velocity, wall shear stress and flow disruption, while decreasing intraluminal pressures. Linear mixed effects modelling demonstrated a log-linear relationship between CBSRI_0.6 and R_v, with a common slope (log(R_v)/CBSRI_0.6) of 0.0079 (95%CI 0.0015-0.0143; p=0.019) for all subjects, equating to a 1.9-fold increase in R_v when roughness increased from Control to OSA levels. At any fixed CBSRI_0.6, the estimated difference in log(R_v) between OSA and Control models was 0.9382 (95%CI 0.0032-1.8732; p=0.049), equating to an 8.7-fold increase in R_v.

CONCLUSION

This study supports the hypothesis that increasing mucosal surface roughness increases velopharyngeal airway resistance, particularly for anatomically narrower OSA airways, and may thus contribute to increased vulnerability to upper airway collapse in OSA patients.

Numerical simulation of thermal water delivery in the human nasal cavity

This work describes an extensive numerical investigation of thermal water delivery for the treatment of inflammatory disorders in the human nasal cavity. The numerical simulation of the multiphase air-droplets flow is based upon the Large Eddy Simulation (LES) technique, with droplets of thermal water described via a Lagrangian approach. Droplet deposition is studied for different sizes of water droplets, corresponding to two different thermal treatments, i.e. aerosol and inhalation. Numerical simulations are conducted on a patient-specific anatomy, employing two different grid sizes, under steady inspiration at two breathing intensities. The results are compared with published in vivo and in vitro data. The effectiveness of the various thermal treatments is then assessed qualitatively and quantitatively, by a detailed analysis of the deposition patterns of the droplets. Discretization effects on the deposition dynamics are addressed. The level of detail of the present work, together with the accuracy afforded by the LES approach, leads to an improved understanding of how the mixture of air-water droplets is distributed within the nose and the paranasal sinuses.

New CFD tools to evaluate nasal airflow

Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. As currently CFD is not a usual tool for rhinologists, a group of engineers in collaboration with experts in Rhinology have developed a very intuitive CFD software. The program MECOMLAND^® only required snapshots from the patient's cross-sectional (tomographic) images, being the output those results originated by CFD, such as airflow distributions, velocity profiles, pressure, temperature, or wall shear stress. This is useful complementary information to cover diagnosis, prognosis, or follow-up of nasal pathologies based on quantitative magnitudes linked to airflow. In addition, the user-friendly environment NOSELAND^® helps the medical assessment significantly in the post-processing phase with dynamic reports using a 3D endoscopic view. Specialists in Rhinology have been asked for a more intuitive, simple, powerful CFD software to offer more quality and precision in their work to evaluate the nasal airflow. We present MECOMLAND^® and NOSELAND^® which have all the expected characteristics to fulfil this demand and offer a proper assessment with the maximum of quality plus safety for the patient. These programs represent a non-invasive, low-cost (as the CT scan is already performed in every patient) alternative for the functional study of the difficult rhinologic case. To validate the software, we studied two groups of patients from the Ear Nose Throat clinic, a first group with normal noses and a second group presenting septal deviations. Wall shear stresses are lower in the cases of normal noses in comparison with those for septal deviation. Besides, velocity field distributions, pressure drop between nasopharynx and the ambient, and flow rates in each nostril were different among the nasal cavities in the two groups. These software modules open up a promising future to simulate the nasal airflow behaviour in virtual surgery intervention scenarios under different pressure or temperature conditions to understand the effects on nasal airflow.

Detection of prion seeding activity in the olfactory mucosa of patients with Fatal Familial Insomnia

Fatal Familial Insomnia (FFI) is a genetic prion disease caused by a point mutation in the prion protein gene (PRNP) characterized by prominent thalamic atrophy, diffuse astrogliosis and moderate deposition of PrP^Sc in the brain. Here, for the first time, we demonstrate that the olfactory mucosa (OM) of patients with FFI contains trace amount of PrP^Sc detectable by PMCA and RT-QuIC. Quantitative PMCA analysis estimated a PrP^Sc concentration of about 1 × 10^-14 g/ml. In contrast, PrP^Sc was not detected in OM samples from healthy controls and patients affected by other neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease and frontotemporal dementia. These results indicate that the detection limit of these assays is in the order of a single PrP^Sc oligomer/molecule with a specificity of 100%.

Inside the brachycephalic nose: conchal regrowth and mucosal contact points after laser-assisted turbinectomy

This prospective observational study analyzed conchal regrowth after laser-assisted turbinectomy (LATE) in brachycephalic dogs and the mucosal contact of regrown conchae. Eighty brachycephalic dogs (41 pugs, 39 French bulldogs [FBs]) that underwent LATE because of obstructing conchae were evaluated by endoscopy 7 days and 6 mo after surgery. At 6 mo, 96% of FBs' and 65% of pugs' nasal cavities showed regrowth of turbinates. FBs showed higher growth grades than pugs. Revision surgery because of reobstructing regrowth was required in the nasal cavities of 17% of FBs and 3% of pugs. The mean number of contact points reduced from 3.0 in FB and 1.7 in pugs before surgery to 1.2 in FB and 0.2 in pugs after conchal regrowth. Recollapse of nares after surgery significantly influenced the frequency of reoccurrence of contact points. LATE was proven to be an effective treatment of intranasal obstruction caused by mucosal contact between conchae. Conchal regrowth commonly occurs after surgical removal, but the new conchae cause less obstruction due to a significant reduction in number of contact points. Revision surgery because of reobstruction is rarely necessary. The important physiologic functions of conchae make nonobstructing regrowth desirable.

Characterizing human nasal airflow physiologic variables by nasal index

Although variations in nasal index (NI) have been reported to represent adaptation to climatic conditions, assessments of NI with airflow variables have not been rigorously investigated. This study uses computational fluid dynamics modeling to investigate the relationship between NI and airflow variables in 16 subjects with normal nasal anatomy. Airflow simulations were conducted under constant inspiratory pressure. Nasal resistance (NR) against NI showed weak association from nostrils to anterior inferior turbinate (R(2)=0.26) and nostril to choanae (R(2)=0.12). NI accounted for 38% and 41% of the respective variation in wall shear stress (WSS) and heat flux (HF) at the nasal vestibule, and 52% and 49% of variability in WSS and HF across the entire nose. HF and WSS had strong correlation with NI<80, and weakly correlated with NI>80; these differences in HF and WSS for NI<80 and NI>80 were not statistically significant. Results suggest strong relationship between NI and both WSS and HF but not NR, particularly in subjects with NI<80.

Large-scale CFD simulations of the transitional and turbulent regime for the large human airways during rapid inhalation

The dynamics of unsteady flow in the human large airways during a rapid inhalation were investigated using highly detailed large-scale computational fluid dynamics on a subject-specific geometry. The simulations were performed to resolve all the spatial and temporal scales of the flow, thanks to the use of massive computational resources. A highly parallel finite element code was used, running on two supercomputers, solving the transient incompressible Navier-Stokes equations on unstructured meshes. Given that the finest mesh contained 350 million elements, the study sets a precedent for large-scale simulations of the respiratory system, proposing an analysis strategy for mean flow, fluctuations and wall shear stresses on a rapid and short inhalation (a so-called sniff). The geometry used encompasses the exterior face and the airways from the nasal cavity, through the trachea and up to the third lung bifurcation; it was derived from a contrast-enhanced computed tomography (CT) scan of a 48-year-old male. The transient inflow produces complex flows over a wide range of Reynolds numbers (Re). Thanks to the high fidelity simulations, many features involving the flow transition were observed, with the level of turbulence clearly higher in the throat than in the nose. Spectral analysis revealed turbulent characteristics persisting downstream of the glottis, and were captured even with a medium mesh resolution. However a fine mesh resolution was found necessary in the nasal cavity to observe transitional features. This work indicates the potential of large-scale simulations to further understanding of airway physiological mechanics, which is essential to guide clinical diagnosis; better understanding of the flow also has implications for the design of interventions such as aerosol drug delivery.

Effects of the ambient temperature on the airflow across a Caucasian nasal cavity

We analyse the effects of the air ambient temperature on the airflow across a Caucasian nasal cavity under different ambient temperatures using CFD simulations. A three-dimensional nasal model was constructed from high-resolution computed tomography images for a nasal cavity from a Caucasian male adult. An exhaustive parametric study was performed to analyse the laminar-compressible flow driven by two different pressure drops between the nostrils and the nasopharynx, which induced calm breathing flow rates ࣈ 5.7 L/min and ࣈ 11.3 L/min. The inlet air temperature covered the range - 10(o) C ⩽ To ⩽50(o) C. We observed that, keeping constant the wall temperature of the nasal cavity at 37(o) C, the ambient temperature affects mainly the airflow velocity into the valve region. Surprisingly, we found an excellent linear relationship between the ambient temperature and the air average temperature reached at different cross sections, independently of the pressure drop applied. Finally, we have also observed that the spatial evolution of the mean temperature data along the nasal cavity can be collapsed for all ambient temperatures analysed with the introduction of suitable dimensionless variables, and this evolution can be modelled with the help of hyperbolic functions, which are based on the heat exchanger theory.

Numerical simulation of airflow fields in two typical nasal structures of empty nose syndrome: a computational fluid dynamics study

BACKGROUND

The pathogenesis of empty nose syndrome (ENS) has not been elucidated so far. Though postulated, there remains a lack of experimental evidence about the roles of nasal aerodynamics on the development of ENS.

OBJECTIVE

To investigate the nasal aerodynamic features of ENS andto explore the role of aerodynamic changes on the pathogenesis of ENS.

METHODS

Seven sinonasal models were numerically constructed, based on the high resolution computed tomography images of seven healthy male adults. Bilateral radical inferior/middle turbinectomy were numerically performed to mimic the typical nasal structures of ENS-inferior turbinate (ENS-IT) and ENS-middle turbinate (ENS-MT). A steady laminar model was applied in calculation. Velocity, pressure, streamlines, air flux and wall shear stress were numerically investigated. Each parameter of normal structures was compared with those of the corresponding pathological models of ENS-IT and ENS-MT, respectively.

RESULTS

ENS-MT: Streamlines, air flux distribution, and wall shear stress distribution were generally similar to those of the normal structures; nasal resistances decreased. Velocities decreased locally, while increased around the sphenopalatine ganglion by 0.20 ± 0.17 m/s and 0.22 ± 0.10 m/s during inspiration and expiration, respectively. ENS-IT: Streamlines were less organized with new vortexes shown near the bottom wall. The airflow rates passing through the nasal olfactory area decreased by 26.27% ± 8.68% and 13.18% ± 7.59% during inspiration and expiration, respectively. Wall shear stresses, nasal resistances and local velocities all decreased.

CONCLUSION

Our CFD simulation study suggests that the changes in nasal aerodynamics may play an essential role in the pathogenesis of ENS. An increased velocity around the sphenopalatine ganglion in the ENS-MT models could be responsible for headache in patients with ENS-MT. However, these results need to be validated in further studies with a larger sample size and more complicated calculating models.

The effects of naris occlusion on mouse nasal turbinate development

Unilateral naris occlusion, a standard method for causing odor deprivation, also alters airflow on both sides of the nasal cavity. We reasoned that manipulating airflow by occlusion could affect nasal turbinate development given the ubiquitous role of environmental stimuli in ontogenesis. To test this hypothesis, newborn mice received unilateral occlusion or sham surgery and were allowed to reach adulthood. Morphological measurements were then made of paraffin sections of the whole nasal cavity. Occlusion significantly affected the size, shape and position of turbinates. In particular, the nasoturbinate, the focus of our quantitative analysis, had a more delicate appearance on the occluded side relative to the open side. Occlusion also caused an increase in the width of the dorsal meatus within the non-occluded and occluded nasal fossae, compared with controls, and the position of most turbinates was altered. These results suggest that a mechanical stimulus from respiratory airflow is necessary for the normal morphological development of turbinates. To explore this idea, we estimated the mechanical forces on turbinates caused by airflow during normal respiration that would be absent as a result of occlusion. Magnetic resonance imaging scans were used to construct a three-dimensional model of the mouse nasal cavity that provided the input for a computational fluid dynamics simulation of nasal airflow. The simulation revealed maximum shear stress values for the walls of turbinates in the 1 Pa range, a magnitude that causes remodeling in other biological tissues. These observations raise the intriguing possibility that nasal turbinates develop partly under the control of respiratory mechanical forces.

Review of computational fluid dynamics in the assessment of nasal air flow and analysis of its limitations

Nasal breathing difficulties (NBD) are a widespread medical condition, yet decisions pertaining to the surgical treatment of chronic NBD still imply a significant degree of subjective judgement of the surgeon. The current standard objective examinations for nasal flow, e.g., rhinomanometry and acoustic rhinomanometry, do not suffice to reliably direct the surgeon on the extent of any necessary surgery. In the last two decades, several groups have therefore considered the numerical simulation of nasal airflow. Currently, these analyses take many hours of labor from the operator, and require a huge amount of computer time and the use of expensive commercial software. Most often, their results are insufficiently validated so that virtual surgery, which is the eventual application, is still absent in clinical practice. Very recently, however, attempts at considering the finest details of the flow are beginning to appear, for example unsteady turbulent simulations validated through laboratory measurements through particle image velocimetry. In this paper, we first discuss recent developments in how computational fluid dynamics (CFD) is helping surgeons improve their understanding of nasal physiology and the effect of surgical modifications on the airflow in the nasal cavity. In a second part, the procedural and modeling challenges that still prevent CFD from being routinely used in clinical practice are surveyed and critically discussed.

Surface mapping for visualization of wall stresses during inhalation in a human nasal cavity

Airflow analysis can assist in better understanding the physiology however the human nasal cavity is an extremely complicated geometry that is difficult to visualize in 3D space, let alone in 2D space. In this paper, an anatomically accurate 3D surface of the nasal passages derived from CT data was unwrapped and transformed into a 2D space, into a UV-domain (where u and v are the coordinates) to allow a complete view of the entire wrapped surface. This visualization technique allows surface flow parameters to be analyzed with greater precision. A UV-unwrapping tool is developed and a strategy is presented to allow deeper analysis to be performed. This includes (i) the ability to present instant comparisons of geometry and flow variables between any number of different nasal cavity models through normalization of the 2D unwrapped surface; (ii) visualization of an entire surface in one view and; (iii) a planar surface that allows direct 1D and 2D analytical solutions of diffusion of inhaled vapors and particles through the nasal walls. This work lays a foundation for future investigations that correlates adverse and therapeutic health responses to local inhalation of gases and particles.

Fluid mechanics based classification of the respiratory efficiency of several nasal cavities

The flow in the human nasal cavity is of great importance to understand rhinologic pathologies like impaired respiration or heating capabilities, a diminished sense of taste and smell, and the presence of dry mucous membranes. To numerically analyze this flow problem a highly efficient and scalable Thermal Lattice-BGK (TLBGK) solver is used, which is very well suited for flows in intricate geometries. The generation of the computational mesh is completely automatic and highly parallelized such that it can be executed efficiently on High Performance Computers (HPCs). An evaluation of the functionality of nasal cavities is based on an analysis of pressure drop, secondary flow structures, wall-shear stress distributions, and temperature variations from the nostrils to the pharynx. The results of the flow fields of three completely different nasal cavities allow their classification into ability groups and support the a priori decision process on surgical interventions.

Changes in nasal airflow and heat transfer correlate with symptom improvement after surgery for nasal obstruction

Surgeries to correct nasal airway obstruction (NAO) often have less than desirable outcomes, partly due to the absence of an objective tool to select the most appropriate surgical approach for each patient. Computational fluid dynamics (CFD) models can be used to investigate nasal airflow, but variables need to be identified that can detect surgical changes and correlate with patient symptoms. CFD models were constructed from pre- and post-surgery computed tomography scans for 10 NAO patients showing no evidence of nasal cycling. Steady-state inspiratory airflow, nasal resistance, wall shear stress, and heat flux were computed for the main nasal cavity from nostrils to posterior nasal septum both bilaterally and unilaterally. Paired t-tests indicated that all CFD variables were significantly changed by surgery when calculated on the most obstructed side, and that airflow, nasal resistance, and heat flux were significantly changed bilaterally as well. Moderate linear correlations with patient-reported symptoms were found for airflow, heat flux, unilateral allocation of airflow, and unilateral nasal resistance as a fraction of bilateral nasal resistance when calculated on the most obstructed nasal side, suggesting that these variables may be useful for evaluating the efficacy of nasal surgery objectively. Similarity in the strengths of these correlations suggests that patient-reported symptoms may represent a constellation of effects and that these variables should be tracked concurrently during future virtual surgery planning.

Frictional resistance sheds light on the multicomponent nature of nasal obstruction: a combined in vivo and computational fluid dynamics study

Exploring nasal flow contributes to better understanding of pathophysiological functions of nasal cavities. We combined the rhinomanometry measurements of 11 patients and computational fluid dynamics (CFD) simulations in 3 nasal airway models to dissect the complex mechanisms that determine nasal flow obstruction: spatial complexity and pressure-dependent deformability of nasal airways. We quantified spatial complexity by calculating longitudinal variations of hydraulic diameter, perimeter and area of nasal cavities, and their impact on flow characteristics by examining the longitudinal variations of the kinetic energy coefficient and the kinetic to potential energy ratio. Airway distensibility variably affected in vivo pressure-flow relationships through the appearance of flow-limitation patterns characterized by maximum flow and/or flow plateau. We quantified deformability and spatial complexity effects on nasal airway resistance by normalizing all data with averaged reference parameters. The results show that discrepancies in nasal flow resistances reflect airway deformability and geometrical complexity, and thereby constitute a framework to better characterize nasal obstruction.

Mechanophysical stimulations of mucin secretion in cultures of nasal epithelial cells

Nasal epithelial cells secret mucins and are exposed in vivo to airflow-induced mechanophysical stresses, including wall shear stress (WSS), temperature, and humidity. In this work, human nasal epithelial cells cultured under air-liquid interface conditions were subjected to fields of airflow-induced oscillatory WSS at different temperature and humidity conditions. Changes in mucin secretion due to WSS were measured and the role of the cytoskeleton in mucin secretion was explored. Mucin secretion significantly increased in response to WSS in a magnitude-dependent manner with respect to static cultures and independently of the airflow temperature and humidity. In static cultures, mucin secretion decreased at high humidity with or without elevation of the temperature with respect to cultures at a comfortable climate. In cultures exposed to WSS, mucin secretion increased at high temperature with respect to cultures at comfortable climate conditions. The polymerization of actin microfilaments was shown to increase mucin secretion under WSS, whereas the dynamics of microtubule polymerization did not affect secretion. In conclusion, the data in this study show that mucin secretion is sensitive to oscillatory WSS as well as high temperature and humidity conditions.

Surgery of the turbinates and "empty nose" syndrome

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The "empty nose" syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in "empty nose" patients are presented.

Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function

The outcomes of aesthetic and functional nasal surgery are difficult to assess objectively because of the intricate balance between nasal form and function. Despite historical emphasis on patient-reported subjective measures, objective measures are gaining importance in both research and the current outcomes-driven health care environment. Objective measures currently available have several shortcomings that limit their routine clinical use. In particular, the low correlation between objective and subjective measures poses a major challenge. However, advances in computer, imaging, and bioengineering technology are now setting the stage for the development of innovative objective assessment tools for nasal surgery that can potentially address some of the current limitations. Assessment of nasal form after aesthetic surgery is evolving from two-dimensional analysis to more sophisticated three-dimensional analysis. Similarly, assessment of nasal function is evolving with the introduction of computational fluid dynamics techniques, which allow for a detailed description of the biophysics of nasal airflow. In this article, we present an overview of objective measures in both aesthetic and functional nasal surgery and discuss future trends and applications that have the potential to change the way we assess nasal form and function.

Septal deviation and nasal resistance: an investigation using virtual surgery and computational fluid dynamics

BACKGROUND

Septal deviation is an extremely common anatomic variation in healthy adults. However, there are no standard criteria to determine when a deviated septum is clinically relevant. Presently, selection of patients for septoplasty is based on mostly clinical examination, which is prone to observer bias and may lead to unsuccessful treatment. The objective of this article is twofold. First, we investigate whether the location of a septal deviation within the nasal passages affects nasal resistance. Second, we test whether computer simulations are consistent with rhinomanometry studies in predicting that anterior septal deviations increase nasal resistance more than posterior deviations.

METHODS

A three-dimensional computational model of a healthy nose was created from computed tomography scans. Geometry-deforming software was used to produce models with septal deviations. Computational fluid dynamics techniques were used to simulate nasal airflow and compute nasal resistance.

RESULTS

Our results revealed that the posterior nasal cavity can accommodate significant septal deviations without a substantial increase in airway resistance. In contrast, a deviation in the nasal valve region more than doubled nasal resistance. These findings are in good agreement with the rhinomanometry literature and with the observation that patients with anterior septal deviations benefit the most from septoplasty.

CONCLUSION

In the model, anterior septal deviations increased nasal resistance more than posterior deviations. This suggests, in agreement with the literature, that other causes of nasal obstruction (dysfunction of the nasal valve, allergy, etc.) should be carefully considered in patients with posterior septal deviations because such deviations may not affect nasal resistance. This study illustrates how computational modeling and virtual manipulation of the nasal geometry are useful to investigate nasal physiology.

On the assumption of steadiness of nasal cavity flow

The unsteady flow through a model of the human nasal cavity is analyzed at a Strouhal number of Sr=0.791 for the complete respiration cycle. A comparison of the essential flow structures in the model geometry and a real nasal cavity shows the relevance of the model data. The analysis of the steady and unsteady solutions indicate that at Reynolds numbers Re> or =1500 the differences of the solutions of the unsteady and steady flow field can be neglected. To be more precise, the comparison of the total pressure loss distribution as a function of mass flux for the steady state and unsteady solutions shows the major differences to occur at increasing mass flux. At transition from inspiration to expiration the unsteady results differ the most from the steady state solutions. At high mass fluxes the total pressure loss of the nasal cavity flow almost matches that of the steady state solutions. The comparison with rhinomanometry measurements confirms the present numerical findings.

Dosimetry of nasal uptake of water-soluble and reactive gases: a first study of interhuman variability

Certain inhaled chemicals, such as reactive, water-soluble gases, are readily absorbed by the nasal mucosa upon inhalation and may cause damage to the nasal epithelium. Comparisons of the spatial distribution of nasal lesions in laboratory animals exposed to formaldehyde with gas uptake rates predicted by computational models reveal that lesions usually occur in regions of the susceptible epithelium where gas absorption is highest. Since the uptake patterns are influenced by air currents in the nose, interindividual variability in nasal anatomy and ventilation rates due to age, body size, and gender will affect the patterns of gas absorption in humans, potentially putting some age groups at higher risk when exposed to toxic gases. In this study, interhuman variability in the nasal dosimetry of reactive, water-soluble gases was investigated by means of computational fluid dynamics (CFD) models in 5 adults and 2 children, aged 7 and 8 years old. Airflow patterns were investigated for allometrically scaled inhalation rates corresponding to resting breathing. The spatial distribution of uptake at the airway walls was predicted to be nonuniform, with most of the gas being absorbed in the anterior portion of the nasal passages. Under the conditions of these simulations, interhuman variability in dose to the whole nose (mass per time per nasal surface area) due to differences in anatomy and ventilation was predicted to be 1.6-fold among the 7 individuals studied. Children and adults displayed very similar patterns of nasal gas uptake; no significant differences were noted between the two age groups.

Development and verification of a high-fidelity computational fluid dynamics model of canine nasal airflow

The canine nasal cavity contains a complex airway labyrinth, dedicated to respiratory air conditioning, filtering of inspired contaminants, and olfaction. The small and contorted anatomical structure of the nasal turbinates has, to date, precluded a proper study of nasal airflow in the dog. This study describes the development of a high-fidelity computational fluid dynamics (CFD) model of the canine nasal airway from a three-dimensional reconstruction of high-resolution magnetic resonance imaging scans of the canine anatomy. Unstructured hexahedral grids are generated, with large grid sizes ((10-100) x 10(6) computational cells) required to capture the details of the nasal airways. High-fidelity CFD solutions of the nasal airflow for steady inspiration and expiration are computed over a range of physiological airflow rates. A rigorous grid refinement study is performed, which also illustrates a methodology for verification of CFD calculations on complex unstructured grids in tortuous airways. In general, the qualitative characteristics of the computed solutions for the different grid resolutions are fairly well preserved. However, quantitative results such as the overall pressure drop and even the regional distribution of airflow in the nasal cavity are moderately grid dependent. These quantities tend to converge monotonically with grid refinement. Lastly, transient computations of canine sniffing were carried out as part of a time-step study, demonstrating that high temporal accuracy is achievable using small time steps consisting of 160 steps per sniff period. Here we demonstrate that acceptable numerical accuracy (between approximately 1% and 15%) is achievable with practical levels of grid resolution (approximately 100 x 10(6) computational cells). Given the popularity of CFD as a tool for studying flow in the upper airways of humans and animals, based on this work we recommend the necessity of a grid dependence study and quantification of numerical error when presenting CFD results in complicated airways.