Evidence of nasal cooling and sensory impairments driving pa
About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). The study finds that distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity can be the responsible factor.

Two fellowship-trained surgeons blindly reviewed 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, 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 this aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients.

- aNSD reported no nasal symptoms – Nasal Obstruction Symptom Evaluation score; 22-item Sino-Nasal Outcome Test score.

- 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 from aNSD: anterior averaged heat flux on the deviated side, inferior turbinate peak heat flux on the 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.

- These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians.

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 the previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling.

The Laryngoscope
Source: https://doi.org/10.1002/lary.29673