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Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation
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 comp...
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| Published in: | The Laryngoscope 2022-03, Vol.132 (3), p.509-517 |
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| container_title | The Laryngoscope |
| container_volume | 132 |
| creator | Malik, Jennifer Spector, Barak M. Wu, Zhenxing Markley, Jennifer Zhao, Songzhu Otto, Bradley A. Farag, Alexander A. Zhao, Kai |
| description | 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 |
| doi_str_mv | 10.1002/lary.29673 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8669045</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2540729079</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4483-af0f9957b82077f446170efb43156f4124fa8bf2cdb93dfd493151695e835df3</originalsourceid><addsrcrecordid>eNp9kV9rFDEUxYModq2--AEk4IsIU_N3MnkRyrbVwqJiC-pTzMwkbcpMMiazW_bbe9etRX3w6cI9vxxO7kHoOSVHlBD2ZrB5e8R0rfgDtKCS00poLR-iBYi8aiT7eoCelHJDCFVcksfogAvKpOB6gb6fbkLvYudw8viDLXbAy5SGEK-wjT2-cLGkvMXn42RDHl2cCz7JYbPTP9k5wAJfbMdpTmPBX8J8DS-mGUxO3CaAnuJT9Mjbobhnd_MQXZ6dXi7fV6uP786Xx6uqE6LhlfXEQ2jVNowo5YWoqSLOt4JTWXuIK7xtWs-6vtW8973QINBaS9dw2Xt-iN7ubad1O7q-g2DZDmbKYYTrmGSD-VuJ4dpcpY1p6loTIcHg1Z1BTj_WrsxmDKVzw2CjS-ti4F5EMU2UBvTlP-hNWucIvzOsZopSwpoaqNd7qsuplOz8fRhKzK43s-vN_OoN4Bd_xr9HfxcFAN0Dt2Fw2_9YmdXx529705-_86QY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2627110286</pqid></control><display><type>article</type><title>Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Malik, Jennifer ; Spector, Barak M. ; Wu, Zhenxing ; Markley, Jennifer ; Zhao, Songzhu ; Otto, Bradley A. ; Farag, Alexander A. ; Zhao, Kai</creator><creatorcontrib>Malik, Jennifer ; Spector, Barak M. ; Wu, Zhenxing ; Markley, Jennifer ; Zhao, Songzhu ; Otto, Bradley A. ; Farag, Alexander A. ; Zhao, Kai</creatorcontrib><description>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 < .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, 132:509–517, 2022</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.29673</identifier><identifier>PMID: 34125439</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>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</subject><ispartof>The Laryngoscope, 2022-03, Vol.132 (3), p.509-517</ispartof><rights>2021 The American Laryngological, Rhinological and Otological Society, Inc.</rights><rights>2022 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4483-af0f9957b82077f446170efb43156f4124fa8bf2cdb93dfd493151695e835df3</citedby><cites>FETCH-LOGICAL-c4483-af0f9957b82077f446170efb43156f4124fa8bf2cdb93dfd493151695e835df3</cites><orcidid>0000-0001-7585-4914 ; 0000-0003-4805-2689 ; 0000-0002-0646-5963</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34125439$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malik, Jennifer</creatorcontrib><creatorcontrib>Spector, Barak M.</creatorcontrib><creatorcontrib>Wu, Zhenxing</creatorcontrib><creatorcontrib>Markley, Jennifer</creatorcontrib><creatorcontrib>Zhao, Songzhu</creatorcontrib><creatorcontrib>Otto, Bradley A.</creatorcontrib><creatorcontrib>Farag, Alexander A.</creatorcontrib><creatorcontrib>Zhao, Kai</creatorcontrib><title>Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>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 < .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, 132:509–517, 2022</description><subject>Case-Control Studies</subject><subject>computational fluid dynamics</subject><subject>Cooling</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Laryngoscopy</subject><subject>nasal airflow dynamics</subject><subject>Nasal Septum - abnormalities</subject><subject>Nasal Septum - diagnostic imaging</subject><subject>Nasal Septum - physiopathology</subject><subject>Nose Deformities, Acquired - complications</subject><subject>Nose Deformities, Acquired - pathology</subject><subject>Nose Deformities, Acquired - physiopathology</subject><subject>Olfaction Disorders - etiology</subject><subject>Rhinomanometry</subject><subject>Rhinometry, Acoustic</subject><subject>Septal deviation</subject><subject>Surgeons</subject><subject>Tomography, X-Ray Computed</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kV9rFDEUxYModq2--AEk4IsIU_N3MnkRyrbVwqJiC-pTzMwkbcpMMiazW_bbe9etRX3w6cI9vxxO7kHoOSVHlBD2ZrB5e8R0rfgDtKCS00poLR-iBYi8aiT7eoCelHJDCFVcksfogAvKpOB6gb6fbkLvYudw8viDLXbAy5SGEK-wjT2-cLGkvMXn42RDHl2cCz7JYbPTP9k5wAJfbMdpTmPBX8J8DS-mGUxO3CaAnuJT9Mjbobhnd_MQXZ6dXi7fV6uP786Xx6uqE6LhlfXEQ2jVNowo5YWoqSLOt4JTWXuIK7xtWs-6vtW8973QINBaS9dw2Xt-iN7ubad1O7q-g2DZDmbKYYTrmGSD-VuJ4dpcpY1p6loTIcHg1Z1BTj_WrsxmDKVzw2CjS-ti4F5EMU2UBvTlP-hNWucIvzOsZopSwpoaqNd7qsuplOz8fRhKzK43s-vN_OoN4Bd_xr9HfxcFAN0Dt2Fw2_9YmdXx529705-_86QY</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Malik, Jennifer</creator><creator>Spector, Barak M.</creator><creator>Wu, Zhenxing</creator><creator>Markley, Jennifer</creator><creator>Zhao, Songzhu</creator><creator>Otto, Bradley A.</creator><creator>Farag, Alexander A.</creator><creator>Zhao, Kai</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7585-4914</orcidid><orcidid>https://orcid.org/0000-0003-4805-2689</orcidid><orcidid>https://orcid.org/0000-0002-0646-5963</orcidid></search><sort><creationdate>202203</creationdate><title>Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation</title><author>Malik, Jennifer ; Spector, Barak M. ; Wu, Zhenxing ; Markley, Jennifer ; Zhao, Songzhu ; Otto, Bradley A. ; Farag, Alexander A. ; Zhao, Kai</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4483-af0f9957b82077f446170efb43156f4124fa8bf2cdb93dfd493151695e835df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Case-Control Studies</topic><topic>computational fluid dynamics</topic><topic>Cooling</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Laryngoscopy</topic><topic>nasal airflow dynamics</topic><topic>Nasal Septum - abnormalities</topic><topic>Nasal Septum - diagnostic imaging</topic><topic>Nasal Septum - physiopathology</topic><topic>Nose Deformities, Acquired - complications</topic><topic>Nose Deformities, Acquired - pathology</topic><topic>Nose Deformities, Acquired - physiopathology</topic><topic>Olfaction Disorders - etiology</topic><topic>Rhinomanometry</topic><topic>Rhinometry, Acoustic</topic><topic>Septal deviation</topic><topic>Surgeons</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malik, Jennifer</creatorcontrib><creatorcontrib>Spector, Barak M.</creatorcontrib><creatorcontrib>Wu, Zhenxing</creatorcontrib><creatorcontrib>Markley, Jennifer</creatorcontrib><creatorcontrib>Zhao, Songzhu</creatorcontrib><creatorcontrib>Otto, Bradley A.</creatorcontrib><creatorcontrib>Farag, Alexander A.</creatorcontrib><creatorcontrib>Zhao, Kai</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malik, Jennifer</au><au>Spector, Barak M.</au><au>Wu, Zhenxing</au><au>Markley, Jennifer</au><au>Zhao, Songzhu</au><au>Otto, Bradley A.</au><au>Farag, Alexander A.</au><au>Zhao, Kai</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2022-03</date><risdate>2022</risdate><volume>132</volume><issue>3</issue><spage>509</spage><epage>517</epage><pages>509-517</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><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.
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 < .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, 132:509–517, 2022</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34125439</pmid><doi>10.1002/lary.29673</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7585-4914</orcidid><orcidid>https://orcid.org/0000-0003-4805-2689</orcidid><orcidid>https://orcid.org/0000-0002-0646-5963</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The Laryngoscope, 2022-03, Vol.132 (3), p.509-517 |
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| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| 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 |
| title | Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation |
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