Using platelet-rich fibrin scaffolds with diced cartilage graft in the treatment of empty nose syndrome

Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.

The effect of decongestion on nasal airway patency and airflow

Nasal decongestant reduces blood flow to the nasal turbinates, reducing tissue volume and increasing nasal airway patency. This study maps the changes in nasal anatomy and measures how these changes affect nasal resistance, flow partitioning between superior and inferior cavity, flow patterns and wall shear stress. High-resolution MRI was applied to capture nasal anatomy in 10 healthy subjects before and after application of a topical decongestant. Computational fluid dynamics simulated nasal airflow at steady inspiratory flow rates of 15 L.min$$^{-1}$$ - 1 and 30 L.min$$^{-1}$$ - 1 . The results show decongestion mainly increases the cross-sectional area in the turbinate region and SAVR is reduced (median approximately 40$$\%$$ % reduction) in middle and lower parts of the cavity. Decongestion reduces nasal resistance by 50$$\%$$ % on average, while in the posterior cavity, nasal resistance decreases by a median factor of approximately 3 after decongestion. We also find decongestant regularises nasal airflow and alters the partitioning of flow, significantly decreasing flow through the superior portions of the nasal cavity. By comparing nasal anatomies and airflow in their normal state with that when pharmacologically decongested, this study provides data for a broad range of anatomy and airflow conditions, which may help characterize the extent of nasal variability.

Objective assessment of nasal resistance among electronic cigarette users

Background Electronic cigarettes have been a popular alternative to tobacco smoking. The effect of tobacco smoking on nasal airway resistance has been investigated before; however, the effect of the aerosol generated by electronic cigarettes is still unknown. This study aimed to evaluate the short-term effects of e-cigarettes on nasal airway resistance. Methods Sixty-one participants were recruited into a vapers group and a control group. The vapers group was instructed to smoke for 5 minutes, and their nasal resistance was measured pre-procedure and at 1 and 5 minutes post-procedure. The results were compared between both groups. Results Repeated measures analysis of variance demonstrated that vaping has no statistically significant effect on total nasal airway resistance. Conclusion Although the differences between both groups were not statistically significant overall, the vapers group showed a reduction in nasal airway resistance in the short term.

Computational Fluid Dynamics Analysis of Nasal Airway Changes after Treatment with C-Expander

The use of the C-expander is an effective treatment modality for maxillary skeletal deficiencies which can cause ailments and significantly reduce life expectancy in late adolescents and young adults. However, the morphological and dynamic effects on the nasal airway have not been reported. The main goal of this study was to evaluate the nasal airway changes after the implementation of a C-expander. A sample of nine patients (8 females, 1 male, age range from 15 to 29 years) was included. The morphology parameters and nasal airway ventilation parameters of pretreatment and posttreatment were measured. All study data were normally distributed. A paired t -test was used to evaluate the changes before and after treatment. After expansion, the mean and standard deviation values of intercanine maxillary width (CMW) and intermolar maxillary width (MMW) increased from 35.75 ± 2.48 mm and 54.20 ± 3.17 mm to 37.87 ± 2.26 mm ( P < 0.05 ) and 56.65 ± 3.10 mm ( P < 0.05 ), respectively. The nasal cavity volume increased from 20320.00 ± 3468.25 mm3 to 23134.70 ± 3918.84 mm3 ( P < 0.05 ). The nasal pressure drop decreased from 36.34 ± 3.99 Pa to 30.70 ± 3.17 Pa ( P < 0.05 ), while the value of the maximum velocity decreased from 6.50 ± 0.31 m/s to 5.85 ± 0.37 m/s ( P < 0.05 ). Nasal resistance dropped remarkably from 0.16 ± 0.14 Pa/ml/s to 0.08 ± 0.06 Pa/ml/s ( P < 0.05 ). The use of C-expander can effectively broaden the area and volume of the nasal airway, having a positive effect in the reduction of nasal resistance and improvement of nasal airway ventilation. For patients suffering from maxillary width deficiency and respiratory disorders, a C-expander may be an alternative method to treat the disease.

Efficiency of modified Goldman’s technique in open pediatric septoplasty

Background Performing nasal surgery on children has been the subject of controversy among surgeons. Specifically, the indications for and timing of septoplasty in children have been debated for the last several decades. In this study, we access the efficacy of the modified Goldman’s technique in dealing with caudal septal deviation in pediatric population suffering from severe nasal obstruction and its effect on nasal functions postoperatively. In this study, 30 pediatric patients suffering from deviated nasal septum who are candidate for septoplasty were included and underwent open septoplasty using modified Goldman’s technique. They were subjected to detailed assessment protocol preoperatively including NOSE scale, anterior rhinomanometry, and CT scans. Follow-up assessment was done at second week postoperative including anterior rhinoscopy and nasal endoscopy and 3 months postoperative including NOSE scale and anterior rhinomanometry. Results There was a statistically significant decrease of the NOSE scale severity to none in 90% of cases. Three months postoperative, all of the patients performed postoperative anterior active rhinomanometry with statistically significant decrease in the postoperative total nasal resistance values with inspiratory values ranging from 0.1 to 0.5 Pa/cm3/s with mean of 0.26 Pa/cm3/s and expiratory nasal resistance values ranging from 0.1 to 0.6 Pa/cm3/s with mean of 0.31 Pa/cm3/s. Conclusions Open septoplasty in children using the modified Goldman’s technique has enabled accurate and conservative approach for correction of nasal septal deviation especially those located in the caudal septal region. The technique also offers a significant reduction of the nasal symptoms postoperatively with marked improvement of the nasal resistance and quality of life in severe cases of deviated nasal septum.

Performance and work of nasal breathing

OBJECTIVE. To evaluate performance (Q) and work (W) of nasal breathing as potential parameters in functional diagnostic of nasal obstruction. MATERIAL AND METHODS. We included in our study 250 patients and we measured by 4-phase-rhinomanometry with decongestion test. We calculated performance Q of the “representative breath” in inspiration and expiration and in total breath, maximal performance Q (Qmax), Work W of nasal breathing in mJ and in mJ/litre and Q in J/min. RESULTS. The interquartile range of Win for representative breath before decongestion is 356 mJ/l, Wex 308 mJ/l, while after decongestion Win is 264 mJ/l and Wex 220 mJ/l. There is no significant difference between work before and after decongestion (p<0.001). Interquartile range for nasal breathing Q before decongestion is 19.2 J/min and after – 14.3 J/min. A significant correlation exists between logarithmic vertex resistance for inspiration and expiration and Qmax for inspiration and expiration (p<0.001). That means that the performance required by breathing depends in the first line on nasal resistance. CONCLUSION. Inspiratory work is 1.2 times higher than expiration work. Increase in nasal airway resistance is followed by increase in maximal nasal performance.

Olfactory Perception and Different Decongestive Response of the Nasal Mucosa During Menstrual Cycle

Background Sex hormones are known to have some influence on nasal functions, but their effect on the decongestive response of the nasal mucosa during menstrual cycle is still undetermined. Objectives The aim of this study was to examine the nasal physiology, the interconnectedness of olfactory and respiratory nasal function and the decongestive response of the nasal mucosa during menstrual cycle. Methods This study included 101 healthy women aged 23.26 ± 4.81 years with a regular menstrual cycle. The nasal respiratory function and the decongestive response of the nasal mucosa were examined by rhinomanometry. Subjective sense of nasal obstruction and the subjective odor intensity were assessed by standardized questionnaires. The odor identification ability was assessed by Sniffin’ Sticks test. Results Statistically significant higher values of nasal resistance (0.311 ± 0.107 Pa/cm3/s) and NOSE score (11.893 ± 13.83) were observed in the ovulatory phase compared to the luteal (0.281 ± 0.084 Pa/cm3/s and 9.029 ± 11.12). An odor identification test score was significantly higher in luteal phase (12.476 ± 1.48) compared to the ovulatory phase (11.971 ± 1.51), opposite of odor intensity. The difference of nasal resistance before and after decongestion was significantly higher in ovulatory phase (0.105 ± 0.097 Pa/cm3/s) compared to the luteal (0.084 ± 0.079 Pa/cm3/s). Correlation between subjective and objective parameters of the examinated nasal functions was not statistically significant in any menstrual phase. Conclusion In the population of women studied, total nasal resistance and NOSE score were significantly lower in the luteal phase of the menstrual cycle. Odor identification was significantly higher in the luteal phase but odor intensity significantly higher in the ovulatory phase. The decongestive response of nasal mucosa was better in the ovulatory phase of the menstrual cycle.

Post-Operative Nasal Obstruction: Comparison between External and Endoscopic Dacryocystorhinostomy

Objectives: The objectives of this study is to compare between endoscopic and external dacryocystorhinostomy (DCR) procedures with regards to both objective and subjective parameters, i.e., incidence of long term post-operative nasal obstruction and patientreported quality of life. Study Design: Prospective study Setting: Tertiary Care University Hospital Participants: Study population included 24 patients undergoing either endoscopic or external DCR with bicanalicular silicone, at the Department of Otorhinolaryngology and Head and Neck Surgery in (removed for blind peer review 1). Main outcome and measure: Changes in nasal resistance was determined by anterior rhinomanometry, and quality of life was assessed by mini rhinoconjuctivitis quality of life questionnaire (MRLQ). Results: Post-operative nasal resistance was significantly increased upon both endoscopic and external DCR (p=0.04); this outcome was temporary and returned to normal after stent removal. Quality of life (QOL) exhibited a significant bimodal improvement in both groups 3 months after the operation (p=0.03), as well as after stent removal (p=0.01). Conclusions: While endoscopic and external DCR with silicone tube stenting both lead to an improvement in quality of life, a significant temporary objective nasal obstruction occurs, more prominently after the endoscopic procedure. Pending future studies, this observed discrepancy may be an appropriate matter to convey to prospective patients prior to choice of procedure.