Correlations between computational fluid dynamics and clinical evaluation of nasal airway obstruction due to septal deviation: An observational study

• Published in: Clinical otolaryngology Vol. 44; no. 4; pp. 603 - 611
• Main Authors: Radulesco, Thomas, Meister, Lionel, Bouchet, Gilles, Varoquaux, Arthur, Giordano, Jérôme, Mancini, Julien, Dessi, Patrick, Perrier, Pierre, Michel, Justin
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2019
• Subjects: Aerodynamics; Airway management; Computational fluid dynamics; Computed tomography; Computer applications; Correlation analysis; Deviation; Evaluation; Fluctuations; Fluid dynamics; Fluid mechanics; functional; Heat; Heat flux; Heat transfer; Hydrodynamics; inferior turbinate hypertrophy; Mathematical analysis; nasal airway obstruction; nasal valve; Observational studies; Patients; Perception; Respiratory tract; Rhinitis; septal deviation; Shear stress; Sinusitis; Statistical analysis; Surgery; Wall shear stresses; inferior turbinate hypertrophy; septal deviation; functional; computational fluid dynamics; nasal valve; nasal airway obstruction; surgery
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.13344

Objectives
The primary objective of this study was to determine how computational fluid dynamics (CFD) could be correlated to clinical evaluation of nasal airway obstruction (NAO) in a population of patients with symptomatic septal deviation (SD). The secondary objective was to determine whether CFD could define which side was the more obstructed.
Design
This was an observational study.
Settings
Few publications have attempted to correlate CFD with clinical evaluation of NAO. This correlation would permit validation and improved interpretation. This study was performed in a university research laboratory specialised in fluid mechanics.
Participants
We included patients referred for septal surgery at our centre. Age range was 19–58 years. Preoperative CT scans were performed. All patients with non‐structural causes of NAO such as rhinitis, sinusitis or tumoral/autoimmune processes (ie, not due to anatomic obstruction) were excluded.
Main outcome measurement
For each nasal fossa, we compared CFD data (total pressure, heat flux, wall shear stress, temperatures, velocity and nasal resistances) with both patient perception scores and rhinomanometry using the Spearman correlation test (rs). Perception scores were graded from 0/4 to 4/4 on each side, based on the patient interview. We also compared CFD‐derived nasal resistances with rhinomanometry‐derived nasal resistances.
Results
Twenty‐two patients complaining of NAO with SD were analysed, and 44 analyses were performed comparing each side with its CFD data. Regarding correlations with patient perception scores, the best values we found were heat flux measures (rs = 0.86). Both rhinomanometry and CFD‐calculated nasal resistances had strong correlations with subjective perception scores (rs = 0.75, P < 0.001 and rs = 0.6, P < 0.001, respectively). We found a statistically significant difference between RMM‐NR and CFD‐NR (P = 0.003). Heat flux analysis allowed us to distinguish the more obstructed side (MOS) and the less obstructed side (LOS) in 100% of patients.
Conclusion
This study aimed to enhance our ability to interpret CFD‐calculated data in the nasal airway. It highlights and confirms that heat flux measures are very closely correlated to patient perception in cases of SD. It also helps to distinguish the more obstructed side from the less obstructed side and could contribute to further CFD studies.