How Nasal Cavity Structure Influences Empty Nose Syndrome Severity: A CFD-Based Analysis

BackgroundEmpty Nose Syndrome (ENS) is a debilitating condition that can occur after partial or total turbinectomy, leading to impaired nasal airflow sensation, breathing difficulties, and sleep disturbances. While ENS is often diagnosed using the ENS6Q questionnaire, its precise causes remain unclear. Some patients with significant turbinate loss develop minor ENS symptoms, whereas others experience severe symptoms after minor mucosal cauterization. Understanding the structural and aerodynamic factors contributing to ENS is crucial for improving diagnosis and prevention. ObjectiveThis study aims to identify correlations between the ENS6Q score and key anatomical and aerodynamic parameters obtained from computational fluid dynamics (CFD) simulations in ENS patients. MethodsWe reconstructed patient-specific nasal cavity models from computed tomography (CT) scans and performed CFD simulations. The analysis focused on five key parameters: the remaining turbinate volume, total mucosal surface area, nasal resistance, average cross-sectional area, and airflow imbalance between the two nasal cavities. These parameters were then compared to ENS6Q scores. ResultsPreliminary findings suggest that a lower remaining turbinate volume, reduced mucosal surface area are associated with higher ENS6Q scores. Additionally, significant airflow asymmetry between the two nasal cavities appears to correlate with more severe symptoms. Furthermore, our data indicate that individuals with larger nasal cavities and greater preoperative mucosal surface area tend to be more resilient to turbinectomy. For an equivalent amount of turbinate resection, patients with initially smaller nasal cavities thus having less mucosal surface experience more severe ENS symptoms. ConclusionBy quantifying the anatomical and aerodynamic characteristics of ENS patients, this study provides new insights into the structural factors contributing to ENS severity. These findings may help refine diagnostic criteria and guide surgical approaches to minimize ENS risk.