Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation

• Published in: The Laryngoscope 2022-03, Vol.132 (3), p.509-517
• Main Authors: Malik, Jennifer, Spector, Barak M., Wu, Zhenxing, Markley, Jennifer, Zhao, Songzhu, Otto, Bradley A., Farag, Alexander A., Zhao, Kai
• Format: Article
• Language: English
• Subjects: Case-Control Studies; computational fluid dynamics; Cooling; Humans; Hypotheses; Laryngoscopy; nasal airflow dynamics; Nasal Septum - abnormalities; Nasal Septum - diagnostic imaging; Nasal Septum - physiopathology; Nose Deformities, Acquired - complications; Nose Deformities, Acquired - pathology; Nose Deformities, Acquired - physiopathology; Olfaction Disorders - etiology; Rhinomanometry; Rhinometry, Acoustic; Septal deviation; Surgeons; Tomography, X-Ray Computed
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.29673

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. Study Design: 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