{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:22:28Z","timestamp":1792840948210,"version":"4.5.0"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T00:00:00Z","timestamp":1559088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","award":["R01 DC013626)."],"award-info":[{"award-number":["R01 DC013626)."]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A nasal septal perforation (NSP) can lead to frustrating symptoms for some patients while remaining completely asymptomatic for others, without a clear mechanism differentiating them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We applied individual computed tomography (CT)\u2010based computational fluid dynamics (CFD) to examine the nasal aerodynamics differences between 5 asymptomatic and 15 symptomatic NSP patients. Patients\u2019 symptoms were confirmed through interviews, 22\u2010item Sino\u2010Nasal Outcome Test score (asymptomatic, 25 \u00b1 18.8; symptomatic, 53.7 \u00b1 18.2), nasal obstruction symptom evaluation score (asymptomatic, 28.0 \u00b1 32.1; symptomatic, 62.2 \u00b1 32.2), and review of medical history.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No statistical differences were found in perforation location, size (asymptomatic, 1.94 \u00b1 1.88 cm<jats:sup>2<\/jats:sup>; symptomatic, 1.36 \u00b1 1.44 cm<jats:sup>2<\/jats:sup>), nasal resistance (asymptomatic, 0.059 \u00b1 0.012 Pa\u00b7s\/mL; symptomatic, 0.063 \u00b1 0.022 Pa\u00b7s\/mL), and computed flow rate shunting across the perforation (asymptomatic, 52.9 \u00b1 30.9 mL\/s; symptomatic, 27.4 \u00b1 23.6 mL\/s; <jats:italic>p<\/jats:italic> &gt; 0.05). However, symptomatic patients had significantly higher wall shear stress (WSS) and heat flux, especially along the posterior perforation margin (WSS, 0.54 \u00b1 0.12 vs 1.15 \u00b1 0.49 Pa, <jats:italic>p<\/jats:italic> &lt; 0.001; heat flux, 0.21 \u00b1 0.05 vs 0.37 \u00b1 0.14 W\/cm<jats:sup>2<\/jats:sup>, <jats:italic>p<\/jats:italic> &lt; 0.01). A WSS cutoff at 0.72 Pa can separate asymptomatic vs symptomatic NSP with 87% sensitivity and 100% specificity. Flow visualization showed flow peaks toward the posterior margin that may be responsible for the high WSS and heat flux among symptomatic NSPs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study is the first CFD examination of asymptomatic and symptomatic NSP with regional aerodynamics and stress abnormalities, beyond size or location, being implicated as the mechanism behind the symptomology of NSP. This finding could serve as an objective basis for future personalized treatment decisions and optimization.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22337","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T23:34:36Z","timestamp":1559172876000},"page":"883-890","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Asymptomatic vs symptomatic septal perforations: a computational fluid dynamics examination"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-2423","authenticated-orcid":false,"given":"Chengyu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"},{"name":"Department of Mechanical Engineering Villanova University  Villanova PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3931-3544","authenticated-orcid":false,"given":"Guillermo","family":"Maza","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Farag","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian P.","family":"Krebs","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhakthi","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2012Head and Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1258\/0022215011908441"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215110000745"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)60373-0"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asj.2005.06.002"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21951"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.5996"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24265"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2500\/ar.2014.5.0090"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812472881"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anl.2018.02.006"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-5073-6"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23653"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2009.01995.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2003.09.016"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.2794204"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21319"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2017.08.031"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27233"}],"container-title":["International Forum of Allergy &amp; 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