Regional peak mucosal cooling predicts the perception of nasal patency
Open accessAbstract
Objectives/Hypothesis: Nasal obstruction is the principal symptom that drives patients with rhinosinus disease to seek medical treatment. However, patient perception of obstruction often bears little relationship to actual measured physical obstruction of airflow. This lack of an objective clinical tool hinders effective diagnosis and treatment. Previous work has suggested that the perception of nasal patency may involve nasal trigeminal activation by cool inspiratory airflow; we attempt to derive clinically relevant variables following this phenomenon. Study Design: Prospective healthy cohort. Methods: Twenty‐two healthy subjects rated unilateral nasal patency in controlled room air using a visual analog scale, followed by rhinomanometry, acoustic rhinometry, and butanol lateralization thresholds (BLTs). Each subject then immediately underwent a computed tomography scan, enabling the construction of a real‐time computational fluid dynamics (CFD) nasal airway model, which was used to simulate nasal mucosa heat loss during steady resting breathing. Results: Among all measured and computed variables, only CFD‐simulated peak heat loss posterior to the nasal vestibule significantly correlated with patency ratings (r = −0.46, P < .01). Linear discriminant analysis predicted patency categories with 89% success rate, with BLT and rhinomanometric nasal resistance being two additional significant variables. As validation, CFD simulated nasal resistance significantly correlated with rhinomanometrically measured resistance (r = 0.41, P < .01). Conclusions: These results reveal that our noses are sensing patency via a mechanism involving localized peak nasal mucosal cooling. The analysis provides a strong rationale for combining the individualized CFD with other objective and neurologic measures to create a novel clinical tool to diagnose nasal obstruction and to predict and evaluate treatment outcomes. Level of Evidence: 4 Laryngoscope, 124:589–595, 2014
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Recent research has validated that the primary physiological mechanism producing the sensation of ample nasal airflow is activation of trigeminal cool thermoreceptors, specifically TRPM8, by nasal mucosal cooling.
“Recent research has validated that the primary physiological mechanism that produces the sensation of ample nasal airflow is activation of trigeminal cool thermoreceptors, specifically TRPM8, by nasal mucosal cooling.224-228”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [225]
The Discussion (page unavailable) reports that regional peak mucosal heat loss significantly contributes to perceived nasal patency. The Introduction and Discussion link cool trigeminal afferents and TRPM8 to cooling, but this study does not establish TRPM8 activation as the primary mechanism producing the sensation of ample airflow. (LLM, conf=0.88)
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References 32 · Cited by 123
Research works printed but not linked: 8
- [23]Zhao K Scherer PW Hajiloo SA Dalton P Effect of anatomy on human nasal air flow and odorant transport patterns: implications for olfaction Chem Senses 2004 6 29 5 365 379 15201204
- [24]Zhao K Dalton P The way the wind blows: implications of modeling nasal airflow Curr Allergy Asthma Rep 2007 5 7 2 117 125 17437682
- [25]Naftali S Rosenfeld M Wolf M Elad D The air-conditioning capacity of the human nose Ann Biomed Eng 2005 4 33 4 545 553 15909660
- [26]Wolf M Naftali S Schroter RC Elad D Air-conditioning characteristics of the human nose J Laryngol Otol 2004 2 118 2 87 92 14979942
- [27]Lindemann J Keck T Wiesmiller K A numerical simulation of intranasal air temperature during inspiration Laryngoscope 2004 6 114 6 1037 1041 15179209
- [29]Naftali S Rosenfeld M Wolf M Elad D The air-conditioning capacity of the human nose Ann Biomed Eng 2005 4 33 4 545 553 15909660
- [31]Meusel T Negoias S Scheibe M Hummel T Topographical differences in distribution and responsiveness of trigeminal sensitivity within the human nasal mucosa Pain 2010 11 151 2 516 521 20817356
- [32]Scheibe M Zahnert T Hummel T Topographical differences in the trigeminal sensitivity of the human nasal mucosa Neuroreport 2006 9 18 17 13 1417 1420 16932150
- Authors
- Zhao, K., Jiang, J., Blacker, K., Lyman, B., Dalton, P., Cowart, B. J., & Pribitkin, E. A.
- Affiliations
- Thomas Jefferson University (US)
- Monell Chemical Senses Center (US)
- Corresponding author
- Zhao, Kai
- Venue
- The Laryngoscope
- Publisher
- Wiley
- Published
- 2013-06-28
- Volume
- 124
- Issue
- 3
- Pages
- 589-595
- ISSN
- 0023-852X (ISSN-L)
- 1531-4995
- PMC
- PMC3841240
- OpenAlex
- W1567111457
- Cited by
- 123
- References
- 32
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 14 · 2023: 17 · 2022: 10 · 2021: 13 · 2020: 7 · 2019: 14 · 2018: 8 · 2017: 9 · 2016: 8 · 2015: 1 · 2014: 10 · 2013: 2
- FWCI
- 6.89
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Laryngoscope (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p50dc006760-05)
- National Institute on Deafness and Other Communication Disorders (P50-DC006760, P50 DC00006760, R03DC008187)
- Topics
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Life Sciences › Neuroscience › Sensory Systems › Olfactory and Sensory Function Studies
- Keywords
- nasal obstruction, nasal airway, computational fluid dynamics, nasal resistance, acoustic rhinometry, rhinomanometry
- MeSH terms
- Adult, Airway Resistance, Body Temperature Regulation, Cold Temperature, Computer Simulation, Female, Humans, Male, Nasal Cavity, Nasal Mucosa, Perception, Pilot Projects, Predictive Value of Tests, Prospective Studies, Reference Values, Rheology, Sensory Thresholds, Tomography, X-Ray Computed, Reproducibility of Results, Cohort Studies, Nasal Obstruction, Linear Models, Rhinomanometry, Young Adult
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