Data from: Airflow in the human nasal passage and sinuses of chronic rhinosinusitis subjects

Chronic Rhinosinusitis (CRS) is a persistent inflammatory disease of the paranasal sinuses that is characterized by clinical symptoms that include a blocked nasal airway, mucus discharge, facial pain, headaches and anosmia [1, 2]. Functional endoscopic sinus surgery (FESS) is performed on patients who fail to improve following medical therapies such as antibiotics and corticosteroids (both systemic and topical nasal sprays). In sinus surgery, the goals are to open the obstructed sinus openings (ostia), to improve sinus ventilation and to restore mucociliary clearance. After initial surgery, a number of patients may continue to have ongoing symptoms and recalcitrant disease for which a more extensive operation such as the Modified Endoscopic Lothrop procedure (MELP) is performed [3–5]. The MELP procedure differs from standard frontal sinus dissection because both the frontal beak that narrows the frontal ostia, and the adjacent upper part of the nasal septum and frontal intersinus septum are removed, creating a single large common drainage pathway for both frontal sinuses. Current understanding of the relationship between nasal geometry (pre- and post-operative) and sinus ventilation is poor; and despite surgical intervention, efficient topical distribution of therapeutic drugs remains a significant challenge. Simulating nasal airflow in this complex patient group will improve our understanding of how surgical strategies affect post-surgical sinus ventilation, as well as providing new understanding for how drug delivery treatments and devices [6–10] can be designed to target delivery to the sinuses. Nasal passage is connected to sinus air pockets through an opening called ostia. Airflow in the human nasal cavity has been extensively studied using fluid dynamic simulations. We refer the reader to [11] and references there on. A number of studies have simulated airflow in both nasal passage and the sinuses [10, 12–24]. Xiong et al [12] simulated nasal airflow at 21 L/min in a normal healthy subject and found very little flow between the nasal passage and the sinuses. At the frontal sinus ostium they observed a limited flow rate of 0.014mL/s during inspiration and 0.018 mL/s during expiration. Zhu et al. [20] evaluated post-surgical airways after uncinectomy and bilateral inferior turbinate reduction and noticed that the surgery that aimed to affect flow partitioning also increased sinus ventilation in only one respiratory phase. The effects of surgery on altering nasal airflow is a complex realm and are not completely understood. Also, these studies do not sufficiently describe airflow in the sinus. This study describes airflow in the nasal passage and sinuses using fluid dynamic simulations. Specifically, airflow in pre-operative and post-operative CRS subject is investigated. FESS in CRS patients is known to increase nasal airway patency, however although this leads to reduced nasal resistance, the role of surgery in altering exchange of air between the sinus and nasal passages is not clear. Transient airflow is simulated in a healthy normal subject, a pre-operative subject with CRS, the same subject post-operatively after a standard FESS procedure, and a post-operative subject after a Lothrop procedure. Particular focus is given to describing airflow at the openings to the frontal and maxillary sinuses.AllFourSubjects_NasoPressureFigure 6 of article. Steady-state nasopharyngeal pressure for all four subjects used in the study.WSS_2LPMWall shear stress data in Figure 5 compare with literature.WSS_Left12LPM.datNormalSubjec1_3PLpreop_3PLPostopSubj2b_3PLDrillOut_Subject