Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation.
Laryngoscope
; 132(3): 509-517, 2022 03.
Article
in En
| MEDLINE
| ID: mdl-34125439
ABSTRACT
OBJECTIVES/HYPOTHESIS:
About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDYDESIGN:
Blinded cohort study.METHODS:
Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients.RESULTS:
aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD 60.50 ± 13.00; aNSD 5.20 ± 5.41; non-NSD 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD 32.60 ± 14.13; aNSD 10.04 ± 10.10; non-NSD 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity).CONCLUSIONS:
This study sheds light on the potential mechanisms of NSD symptomatology distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE 3 Laryngoscope, 132509-517, 2022.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Nose Deformities, Acquired
/
Nasal Septum
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Laryngoscope
Journal subject:
OTORRINOLARINGOLOGIA
Year:
2022
Document type:
Article
Affiliation country: