title: Regional peak mucosal cooling predicts the perception of nasal patency.
abstract: OBJECTIVE
  Nasal obstruction is the principal symptom that drives patients with rhinosinus disease to seek medical treatment. However, patient perception of obstruction often bears little relationship to actual measured physical obstruction of airflow. This lack of an objective clinical tool hinders effective diagnosis and treatment. Previous work has suggested that the perception of nasal patency may involve nasal trigeminal activation by cool inspiratory airflow; we attempt to derive clinically relevant variables following this phenomenon.
  
  
  METHODS
  Prospective healthy cohort.
  
  
  METHODS
  Twenty-two healthy subjects rated unilateral nasal patency in controlled room air using a visual analog scale, followed by rhinomanometry, acoustic rhinometry, and butanol lateralization thresholds (BLTs). Each subject then immediately underwent a computed tomography scan, enabling the construction of a real-time computational fluid dynamics (CFD) nasal airway model, which was used to simulate nasal mucosa heat loss during steady resting breathing.
  
  
  RESULTS
  Among all measured and computed variables, only CFD-simulated peak heat loss posterior to the nasal vestibule significantly correlated with patency ratings (r = -0.46, P < .01). Linear discriminant analysis predicted patency categories with 89% success rate, with BLT and rhinomanometric nasal resistance being two additional significant variables. As validation, CFD simulated nasal resistance significantly correlated with rhinomanometrically measured resistance (r = 0.41, P < .01).
  
  
  CONCLUSIONS
  These results reveal that our noses are sensing patency via a mechanism involving localized peak nasal mucosal cooling. The analysis provides a strong rationale for combining the individualized CFD with other objective and neurologic measures to create a novel clinical tool to diagnose nasal obstruction and to predict and evaluate treatment outcomes.
authors.affiliation: Monell Chemical Senses Center, Philadelphia, Pennsylvania, U.S.A; Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhao
authors.forename: Jianbo
authors.initials: J
authors.lastname: Jiang
authors.forename: Kara
authors.initials: K
authors.lastname: Blacker
authors.forename: Brian
authors.initials: B
authors.lastname: Lyman
authors.forename: Pamela
authors.initials: P
authors.lastname: Dalton
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Cowart
authors.forename: Edmund A
authors.initials: EA
authors.lastname: Pribitkin
mesh_terms: D000328:Adult; D000403:Airway Resistance / Q000502:physiology*; D001833:Body Temperature Regulation; D015331:Cohort Studies; D003080:Cold Temperature; D003198:Computer Simulation; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000502:physiology; D009297:Nasal Mucosa / Q000000981:diagnostic imaging / Q000502:physiology*; D015508:Nasal Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010465:Perception / Q000502:physiology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012212:Rheology / Q000379:methods; D025363:Rhinomanometry / Q000379:methods; D012684:Sensory Thresholds; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: Nasal congestion; TRPM8; cool perception; nasal cooling; nasal obstruction; nasal trigeminal sensitivity