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Normative ranges of nasal airflow variables in healthy adults

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Virtual surgery planning based on computational fluid dynamics (CFD) simulations of nasal airflow has the potential to improve surgical outcomes for patients with nasal airway obstruction (NAO). Virtual surgery planning requires normative ranges of airflow variables, but few studies to date have quantified inter-individual variability of nasal airflow among healthy subjects. This study reports CFD simulations of nasal airflow in 47 healthy adults.

Methods

Anatomically accurate three-dimensional nasal models were reconstructed from cone beam computed tomography scans and used for steady-state inspiratory airflow simulations with a bilateral flowrate of 250 ml/s. Normal subjective sensation of nasal patency was confirmed using the nasal obstruction symptom evaluation and visual analog scale. Healthy ranges for several CFD variables known to correlate with subjective nasal patency were computed, including unilateral airflow, nasal resistance, airspace minimal cross-sectional area (mCSA), heat flux (HF), and surface area stimulated by mucosal cooling (defined as the area where HF > 50 W/m2). The normative ranges were targeted to contain 95% of the healthy population and computed using a nonparametric method based on order statistics.

Results

A wide range of inter-individual variability in nasal airflow was observed among healthy subjects. Unilateral airflow varied from 60 to 191 ml/s, airflow partitioning ranged from 23.8 to 76.2%, and unilateral mCSA varied from 0.24 to 1.21 cm2. These ranges are in good agreement with rhinomanometry and acoustic rhinometry data from the literature. A key innovation of this study are the normative ranges of flow variables associated with mucosal cooling, which recent research suggests is the primary physiological mechanism of nasal airflow sensation. Unilateral HF ranged from 94 to 281 W/m2, while the surface area stimulated by cooling ranged from 27.4 to 64.3 cm2.

Conclusions

These normative ranges may serve as targets in future virtual surgery planning for patients with NAO.

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Notes

  1. This inlet boundary condition should be distinguished from a flat velocity profile imposed at the nostrils, which has been shown to yield less accurate results than a pressure boundary condition imposed at a spherical surface in front of the face [48]. Here, a pressure boundary condition (not a flat velocity profile) is applied at the nostrils. For a given mesh size, truncation of the geometry at the nostrils provides a higher mesh density inside the nasal passages, which is expected to provide greater accuracy.

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Funding

This study was funded by Grant R01EB009557 from the National Institutes of Health/National Institute of Biomedical Imaging and Bioengineering to the Medical College of Wisconsin (MCW) and by subcontract from MCW to the University of North Carolina at Chapel Hill, Duke University, and Marquette University School of Dentistry.

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Author notes

  1. Azadeh A. T. Borojeni and Guilherme J. M. Garcia have contributed equally to this paper.

Authors and Affiliations

  1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Azadeh A. T. Borojeni, Guilherme J. M. Garcia, Masoud Gh. Moghaddam & John S. Rhee

  2. Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Azadeh A. T. Borojeni, Guilherme J. M. Garcia & Masoud Gh. Moghaddam

  3. Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA

    Dennis O. Frank-Ito

  4. Computational Biology and Bioinformatics Program, Duke University, Durham, NC, USA

    Dennis O. Frank-Ito

  5. Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA

    Dennis O. Frank-Ito

  6. Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Julia S. Kimbell

  7. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    Purushottam W. Laud

  8. Department of Oral Medicine and Oral Radiology, Marquette University School of Dentistry, Milwaukee, WI, USA

    Lisa J. Koenig

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  1. Azadeh A. T. Borojeni
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Correspondence to Guilherme J. M. Garcia.

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Borojeni, A.A.T., Garcia, G.J.M., Moghaddam, M.G. et al. Normative ranges of nasal airflow variables in healthy adults. Int J CARS 15, 87–98 (2020). https://doi.org/10.1007/s11548-019-02023-y

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