title: Perception of better nasal patency correlates with increased mucosal cooling after surgery for nasal obstruction.
abstract: OBJECTIVE
  To (1) quantify mucosal cooling (ie, heat loss) spatially in the nasal passages of nasal airway obstruction (NAO) patients before and after surgery using computational fluid dynamics (CFD) and (2) correlate mucosal cooling with patient-reported symptoms, as measured by the Nasal Obstruction Symptom Evaluation (NOSE) and a visual analog scale (VAS) for sensation of nasal airflow.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Academic tertiary medical center.
  
  
  METHODS
  Computed tomography (CT) scans and NOSE and VAS surveys were obtained from 10 patients before and after surgery to relieve NAO. Three-dimensional models of each patient's nasal anatomy were used to run steady-state CFD simulations of airflow and heat transfer during inspiration. Heat loss across the nasal vestibule and the entire nasal cavity, as well as the surface area of mucosa exposed to heat fluxes >50 W/m(2), were compared pre- and postoperatively.
  
  
  RESULTS
  After surgery, heat loss increased significantly on the preoperative most obstructed side (P < .0002). A larger surface area of nasal mucosa was exposed to heat fluxes >50 W/m(2) after surgery. The best correlation between patient-reported and CFD measures of nasal patency was obtained for NOSE against surface area in which heat fluxes were >50 W/m(2) (Pearson r = -0.76).
  
  
  CONCLUSIONS
  A significant postoperative increase in mucosal cooling correlates well with patients' perception of better nasal patency after NAO surgery. Computational fluid dynamics-derived heat fluxes may prove to be a valuable predictor of success in NAO surgery.
authors.affiliation: Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Corbin D
authors.initials: CD
authors.lastname: Sullivan
authors.forename: Guilherme J M
authors.initials: GJ
authors.lastname: Garcia
authors.forename: Dennis O
authors.initials: DO
authors.lastname: Frank-Ito
authors.forename: Julia S
authors.initials: JS
authors.lastname: Kimbell
authors.forename: John S
authors.initials: JS
authors.lastname: Rhee
mesh_terms: D000403:Airway Resistance / Q000502:physiology; D001833:Body Temperature Regulation / Q000502:physiology*; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008953:Models, Anatomic; D009297:Nasal Mucosa / Q000502:physiology*; D015508:Nasal Obstruction / Q000601:surgery*; D009666:Nose / Q000502:physiology*; D010465:Perception / Q000502:physiology; D011184:Postoperative Period; D011446:Prospective Studies; D012123:Pulmonary Ventilation / Q000502:physiology*; D064232:Visual Analog Scale
keywords: NOSE scale; computational fluid dynamics (CFD); heat flux; mucosal cooling; nasal obstruction; nasal surgery; septoplasty; turbinate reduction; visual analog scale (VAS)