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Johnsen SG. Computational Rhinology: Unraveling Discrepancies between In Silico and In Vivo Nasal Airflow Assessments for Enhanced Clinical Decision Support. Bioengineering (Basel) 2024; 11:239. [PMID: 38534513 PMCID: PMC10967811 DOI: 10.3390/bioengineering11030239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/28/2024] Open
Abstract
Computational rhinology is a specialized branch of biomechanics leveraging engineering techniques for mathematical modelling and simulation to complement the medical field of rhinology. Computational rhinology has already contributed significantly to advancing our understanding of the nasal function, including airflow patterns, mucosal cooling, particle deposition, and drug delivery, and is foreseen as a crucial element in, e.g., the development of virtual surgery as a clinical, patient-specific decision support tool. The current paper delves into the field of computational rhinology from a nasal airflow perspective, highlighting the use of computational fluid dynamics to enhance diagnostics and treatment of breathing disorders. This paper consists of three distinct parts-an introduction to and review of the field of computational rhinology, a review of the published literature on in vitro and in silico studies of nasal airflow, and the presentation and analysis of previously unpublished high-fidelity CFD simulation data of in silico rhinomanometry. While the two first parts of this paper summarize the current status and challenges in the application of computational tools in rhinology, the last part addresses the gross disagreement commonly observed when comparing in silico and in vivo rhinomanometry results. It is concluded that this discrepancy cannot readily be explained by CFD model deficiencies caused by poor choice of turbulence model, insufficient spatial or temporal resolution, or neglecting transient effects. Hence, alternative explanations such as nasal cavity compliance or drag effects due to nasal hair should be investigated.
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Wei H, Wan L, Zhang Y, Li Y, Xu W, Li Y, Han D. Value of Opening the Middle Meatus in Patients With Nasal Airway Obstruction. EAR, NOSE & THROAT JOURNAL 2023; 102:NP489-NP498. [PMID: 36916238 DOI: 10.1177/01455613231163737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES While surgeries to correct the anatomical malformations that cause nasal airway obstruction (NAO) are generally successful, the outcomes of such procedures are often unsatisfactory. The aim of the present study was to assess the value of opening the middle meatus in patients with NAO. METHODS Thirty-four patients with nasal obstruction due to nasal septal deviation were included in this study. After randomization, the middle meatus was either opened or not opened during septoplasty. The patients were evaluated through pre- and postoperative rhinomanometry and acoustic rhinometry. The Visual Analog Scale (VAS) scores of subjective symptoms along with responses to the 20-item Sinonasal Outcome Test (SNOT-20) were obtained before surgery and three months after surgery. RESULTS The VAS scores and SNOT-20 responses improved significantly in both groups after surgery. The effective treatment rate based on the nasal congestion score (NCS) was 64.7% in the single group (septoplasty alone) and 100% in the combined group (septoplasty in conjunction with opening the middle meatus), and the difference was statistically significant (P = .018). In both groups, surgery significantly improved nasal flow, resistance, minimal cross-sectional area, cross-sectional area 6 cm (CA6) from the anterior nostril and nasal volume. Nasal volume and CA6 after surgery were statistically different between the 2 groups (P = .004 and .019, respectively). CONCLUSIONS Opening the middle meatus may further improve the subjective perception of patency on the basis of septoplasty.
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Affiliation(s)
- Hongzheng Wei
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Lianqi Wan
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Department of Allergy, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
| | - Wen Xu
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
| | - Yunchuan Li
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, People's Republic of China
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ERDOĞAN MM, UĞUR L. Changes in nasolabial angle may alter nasal valve morphology and airflow: a computational fluid dynamics study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1250202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: Nasal valve (NV) dysfunctions are a significant cause of nasal obstruction. Changes in the nasolabial angle (NLA) may also cause changes in NV morphology. The effect of changes in the 3D structure of the nasal valve region (NVR) on nasal airflow has yet to be studied sufficiently. The accuracy of computational fluid dynamics (CFD) simulation results of nasal airflow has been confirmed by in vitro tests. Therefore, this study aimed to evaluate the effect of changes in NV structure and volume on nasal airflow based on the CFD method.
Material and Method: We used CT images to create a 3D structural model of the NVR. First, CT images were transferred to MIMICS® software, and the nasal air passage was modeled. A solid reference model of the NVR was then created using SolidWorks software. Five different solid 3D nasal valve models were created with nasolabial angles of 85˚ in Model 1, 90˚ in Model 2, 95˚ in Model 3, 100˚ in Model 4, and 105˚ in Model 5. To simulate breathing during rest and exercise using the CFD method, the unilateral nasal airflow rates were set at 150 ml/s and 500 ml/s, respectively. The CFD method was then used to calculate each model’s airflow properties. Finally, the volumes of the models, pressure at the NV outlet, and airflow velocity were evaluated and calculated to investigate each model’s NV airflow characteristics.
Results: Our study found a significant correlation between the nasolabial angle (NLA) and NVR volume (r=-0.998, p=0.000), flow rate and velocity (r=0.984, p=0.000), velocity and maximum pressure (r=0.920, p=0.000), velocity and minimum pressure (r=-0.969, p=0.000), flow rate and maximum pressure (r=0.974, p=0.000), and flow rate and minimum pressure (r=-0.950, p=0.000). There was no correlation between NLA increase and nasal airflow velocity. We determined that the highest pressure and lowest airflow velocity values were in the upper angle region and that the lowest pressure and highest airflow velocity values were at the bottom of the NVR in all models.
Conclusion: Using the CFD method, we found a decrease in NVR volume and an increase in airflow velocity with an increase in NLA. In addition, we found that the pressure values in the NVR did not change significantly with the increase in NLA.
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Affiliation(s)
- Mehmet Mustafa ERDOĞAN
- Amasya University Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery
| | - Levent UĞUR
- Amasya University, Faculty of Engineering, Department of Mechanical Engineering
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Shkorbotun VO, Ovsiienko MO. IMPACT OF THE NASAL VALVE SHAPE ON THE OLFACTORY FUNCTION AND SUBJECTIVE PERCEPTION OF THE NASAL BREATHING. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2640-2645. [PMID: 36591747 DOI: 10.36740/wlek202211116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim: To study the impact of the internal nasal valve shape on respiratory and olfactory nose function as well as on quality of life. PATIENTS AND METHODS Materials and methods: The study involved 17 volunteers who noted satisfaction of nasal breathing in the absence of changes during endorhinoscopy. The study was con¬ducted in two stages: stage 1 involved assessing initial indicators of quality of life by the SNOT-22 questionnaire, performing active anterior rhinomanometry, and estimating the olfactory function (Sniffin' Sticks); stage 2 consisted in re-assessing the mentioned indicators after changing the shape and lumen of the internal nasal valve. The sodium alginate self-hardening gel was used for simulating the narrowing of the nasal valve. It was applied to the mucous in the upper part of the nasal valve area, obturating the diffuser above the level of attachment of the middle nasal turbinate to a depth of 3-4 mm from nasal vestibule. RESULTS Results: Air resistance did not change significantly after partial blockage of the internal nasal valve, although, 16 out of 17 patients showed signs of hyposmia with an average Sniffin' Sticks test score 8.68 ± 0.15. CONCLUSION Conclusions: The simulated partial blockage of the internal nasal valve lumen in its upper part in the area of the diffuser does not significantly affect the resistance of the air passing through the nasal passages, but the olfactory function is impaired, which is reflected the quality of life.
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Affiliation(s)
- Volodymyr O Shkorbotun
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE; SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | - Maksym O Ovsiienko
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; MUNICIPAL NON-PROFIT ENTERPRISE «KYIV CITY CLINICAL HOSPITAL No.9», KYIV, UKRAINE
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Schoustra E, van Maanen P, den Haan C, Ravesloot MJL, de Vries N. The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review. Brain Sci 2022; 12:1446. [PMID: 36358372 PMCID: PMC9688553 DOI: 10.3390/brainsci12111446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2023] Open
Abstract
Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.
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Affiliation(s)
- Emily Schoustra
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Peter van Maanen
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Chantal den Haan
- Department of Research and Epidemiology, Medical Library, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Madeline J. L. Ravesloot
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology—Head and Neck Surgery, OLVG, 1061 AE Amsterdam, The Netherlands
- Department of Oral Kinesiology, Academisch Centrum Tandheelkunde Amsterdam, MOVE Research Institute Amsterdam, University of Amsterdam and VU Amsterdam, 1081 LA Amsterdam, The Netherlands
- Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery Antwerp University Hospital, 2650 Antwerp, Belgium
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Zhang Z, Wang H, Sun D, Fei N, Li Y, Han D. Classification of facial phenotypes in Asian patients with obstructive sleep apnea. Acta Otolaryngol 2022; 142:712-720. [PMID: 36112047 DOI: 10.1080/00016489.2022.2108552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUD The facial phenotypes of Asian obstructive sleep apnea (OSA) patients remain unclear. OBJECTIVES (1) To describe the facial features of OSA patients. (2) To develop a model based on facial contour indicators to predict OSA. (3) To classify the facial phenotypes of Asian OSA patients. MATERIALS AND METHODS 110 patients with OSA (apnea-hypopnea index [AHI] ≥ 10/h) and 50 controls (AHI< 10/h) were selected to measure facial contour indicators. Indicators were compared between OSA patients and the control group. We used multivariable linear regression analysis to predict OSA severity and K-means cluster analysis to classify OSA patients into different phenotypes. RESULTS We built a model to predict OSA which explained 49.1% of its variance and classified OSA patients into four categories. Cluster 1 (Skeletal type) had the narrowest facial width indicators with narrowing of the retroglossal airway. Cluster 2 (Obese type) had the widest face, and narrowest hard palate, retropalatal, and hypopharyngeal airways. Cluster 3 (Nose type) had the narrowest nasal cavity. Cluster 4 (Long type) had the longest airway length. CONCLUSIONS AND SIGNIFICANCE Patients with OSA were classified into four categories, each of which identified different anatomic risk factors that can be used to select the treatment.
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Affiliation(s)
- Zishanbai Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Huijun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Dance Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Nanxi Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yanru Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
| | - Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, People's Republic of China
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高 翔, 武 骏, 魏 洪, 徐 文, 韩 德. [Correlation between nasal mucosal temperature change and nasal airflow perception]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:401-406. [PMID: 35483696 PMCID: PMC10128267 DOI: 10.13201/j.issn.2096-7993.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 06/14/2023]
Abstract
The mechanism of nasal airflow perception remains little known. It is currently believed that the main mechanism for perceiving nasal patency is to activate transient receptor potential melastatin subtype 8. Computer fluent dynamics show that increased airflow and heat flux are associated with higher subjective scores. Similarly, physical measurements of the nasal cavity using a temperature probe show a correlation between the lower nasal mucosa temperature and better results. Trigeminal function detection also indirectly confirms this. This literature review aimed to explore the role of nasal mucosal temperature change in the subjective perception of nasal patency and the secondary aim was to appraise the relevant evidence about the mechanism.
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Affiliation(s)
- 翔 高
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - 骏 武
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - 洪政 魏
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - 文 徐
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
| | - 德民 韩
- 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京,100730)Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital and Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, 100730, China
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