Peak Sinus Pressures During Sneezing in Healthy Controls and Post–Skull Base Surgery Patients
- 12 November 2019
- journal article
- research article
- Published by Wiley in The Laryngoscope
- Vol. 130 (9), 2138-2143
- https://doi.org/10.1002/lary.28400
Abstract
Objectives/Hypothesis Patients are frequently advised to sneeze with an open mouth and avoid nose‐blowing following an endoscopic endonasal approache (EEA) to the skull base, despite a lack of quantitative evidence. This study applies computational fluid dynamics (CFD) to quantify sinus pressures along the skull base during sneezing. Study Design Case–control series. Methods Computed tomography or magnetic resonance imaging scans of four post‐EEA patients and four healthy controls were collected and analyzed utilizing CFD techniques. A pressure drop of 6,000 Pa was applied to the nasopharynx based on values in the literature to simulate expiratory nasal airflow during sneezing. Peak pressures along the skull base in frontal, ethmoid, and sphenoid sinuses were collected. Results Significant increases in skull base peak pressure was observed during sneezing, with significant individual variations from 2,185 to 5,685 Pa. Interestingly, healthy controls had significantly higher pressures compared to post‐EEA patients (5179.37 ± 198.42 Pa vs. patients 3,347.82 ± 1,472.20 Pa, P < .05), which could be related to higher anterior nasal resistance in unoperated healthy controls (0.44 ± 0.22 vs. 0.31 ± 0.16 Pa/mL/sec for patients, P = .38). The sinus pressure buildup may be due to airway resistance functioning as a valve preventing air from being released quickly. Supporting this theory, there was a strong correlation (r = 0.82) between peak skull base pressure and the ratio of anterior resistance to total resistance. Within‐subject variation in pressures between different skull base regions was much lower (average = ~5%). Conclusions This study provided the first quantitative analysis of air pressure along the skull base during sneezing in post‐EEA patients through CFD, suggesting that pressure buildup may depend on individual anatomy. Level of Evidence 3b Laryngoscope, 2019Keywords
This publication has 26 references indexed in Scilit:
- Complication Avoidance in Endoscopic Skull Base SurgeryOtolaryngologic Clinics of North America, 2016
- Computer simulations of pressure and velocity fields in a human upper airway during sneezingComputers in Biology and Medicine, 2016
- Computational Fluid Dynamics as Surgical Planning Tool: A Pilot Study on Middle Turbinate ResectionThe Anatomical Record, 2014
- What is normal nasal airflow? A computational study of 22 healthy adultsInternational Forum of Allergy & Rhinology, 2014
- Regional peak mucosal cooling predicts the perception of nasal patencyThe Laryngoscope, 2013
- A New Porcine Skull Base ModelOtolaryngology -- Head and Neck Surgery, 2009
- Laser‐assisted cerebrospinal fluid leak repair: An animal model to test feasibilityOtolaryngology -- Head and Neck Surgery, 2007
- Effect of Anatomy on Human Nasal Air Flow and Odorant Transport Patterns: Implications for OlfactionChemical Senses, 2004
- COMPUTATIONAL FLUID DYNAMICS SIMULATIONS OF INSPIRATORY AIRFLOW IN THE HUMAN NOSE AND NASOPHARYNXInhalation Toxicology, 1998
- Numerical Simulation of Airflow in the Human Nasal CavityJournal of Biomechanical Engineering, 1995