{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:54:50Z","timestamp":1791291290459,"version":"4.3.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T00:00:00Z","timestamp":1589155200000},"content-version":"am","delay-in-days":366,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2019,5,11]],"date-time":"2019-05-11T00:00:00Z","timestamp":1557532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["R01 DC013626"],"award-info":[{"award-number":["R01 DC013626"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000055","name":"National Institute on Deafness and Other Communication Disorders","doi-asserted-by":"publisher","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>Empty nose syndrome (ENS) remains highly controversial, with aggressive inferior turbinate reduction (ITR) or mucociliary dysfunction frequently implicated. However, the appropriate degree of ITR is highly debatable.<\/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 5 patients receiving relatively aggressive ITR but with no ENS symptoms, and compared them to 27 symptomatic ENS patients who all had histories of aggressive ITRs, and 42 healthy controls. Patients\u2019 surgical outcomes were confirmed with 22\u2010item Sino\u2010Nasal Outcome Test (SNOT\u201022) (ITR: 6.40 \u00b1 4.56; ENS: 58.2 \u00b1 15.9; healthy: 13.2 \u00b1 14.9), Nasal Obstruction Symptom Evaluation (NOSE) scores (ITR: 4.00 \u00b1 2.24; ENS: 69.4 \u00b1 17.1; healthy: 11.9 \u00b1 12.9), and Empty Nose Syndrome 6\u2010Item Questionnaire (ENS6Q) (\u226511 for ENS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both aggressive ITR without ENS symptoms and symptomatic ENS patients had significantly lower nasal resistance (ITR: 0.059 \u00b1 0.020 Pa\u00b7s\/mL; ENS: 0.052 \u00b1 0.015 Pa\u00b7s\/mL; healthy: 0.070 \u00b1 0.021 Pa\u00b7s\/mL) and higher cross\u2010sectional areas surrounding the inferior turbinate (ITR: 0.94 \u00b1 0.21 cm<jats:sup>2<\/jats:sup>; ENS: 1.19 \u00b1 1.05 cm<jats:sup>2<\/jats:sup>; healthy: 0.42 \u00b1 0.22 cm<jats:sup>2<\/jats:sup>) than healthy controls. The lack of significant differences among patient groups indicated similar degrees of surgeries between ITR with and without ENS symptom cohorts. However, symptomatic ENS patients have paradoxical significantly less airflow in the inferior meatus (ITR: 47.7% \u00b1 23.6%; ENS: 25.8% \u00b1 17.6%; healthy: 36.5 \u00b1 15.9%; both <jats:italic>p<\/jats:italic> &lt; 0.01), but higher airflow around the middle meatus (ITR: 49.7% \u00b1 22.6%; ENS: 66.5% \u00b1 18.3%; healthy: 49.9% \u00b1 15.1%, <jats:italic>p<\/jats:italic> &lt; 0.0001) than aggressive ITR without symptoms and controls. Aggressive ITR patients have increased inferior meatus airflow as expected (<jats:italic>p<\/jats:italic> &lt; 0.05). This imbalanced airflow produced less inferior wall\u2010shear\u2010stress distribution among symptomatic ENS patients only (ITR: 42.45% \u00b1 11.4%; ENS: 32.2% \u00b1 12.6%; healthy: 49.7% \u00b1 9.9%). ENS patients (n = 12) also had impaired nasal trigeminal function, as measured by menthol lateralization detection thresholds (ITR: 15.2 \u00b1 1.2; ENS: 10.3 \u00b1 3.9; healthy: 13.8 \u00b1 3.09, both <jats:italic>p<\/jats:italic> &lt; 0.0001). Surprisingly, aggressive ITR patients without ENS symptoms have better menthol lateralization detection thresholds (LDTs) than healthy controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although turbinate tissue loss is linked with ENS, the degree of ITR that might distinguish postoperative patient satisfaction in their nasal breathing vs development of ENS symptoms is unclear. Our results suggest that a combination of distorted nasal aerodynamics and loss of mucosal sensory function may potentially lead to ENS symptomology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22350","type":"journal-article","created":{"date-parts":[[2019,5,11]],"date-time":"2019-05-11T13:56:32Z","timestamp":1557582992000},"page":"891-899","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Computational fluid dynamic analysis of aggressive turbinate reductions: is it a culprit of empty nose syndrome?"],"prefix":"10.1002","volume":"9","author":[{"given":"Jennifer","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus 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