{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:57:47Z","timestamp":1784865467918,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,1,17]],"date-time":"2021-01-17T00:00:00Z","timestamp":1610841600000},"content-version":"am","delay-in-days":366,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T00:00:00Z","timestamp":1579219200000},"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 to K.Zz"],"award-info":[{"award-number":["R01 DC013626 to K.Zz"]}],"id":[{"id":"10.13039\/100000055","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["R21 DC017530"],"award-info":[{"award-number":["R21 DC017530"]}],"id":[{"id":"10.13039\/100000001","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":[[2020,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Empty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Cotton placement into the inferior meatus often alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by cotton testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six ENS patients (12 sides) with pre\u2010existing sinus computed tomography (CT) imaging were enrolled after marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6\u2010Item Questionnaire [ENS6Q] of &gt;7 points) with office\u2010based cotton testing. The fashioned cotton plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect cotton contouring in the inferior meatus. CT imaging from pre\u2010 and post\u2010cotton placement was analyzed using comparative CFD techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After cotton placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 \u00b1 4.1 to 3.1 \u00b1 2.4; <jats:italic>p<\/jats:italic> &lt; 0.001) were recorded. Using CFD, cotton placement produced an expected 21% increase in upper airway resistance (<jats:italic>p<\/jats:italic> &lt; 0.05). However, a significant shift in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (\u221241%; <jats:italic>p<\/jats:italic> &lt; 0.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Objective CFD assessment confirmed that the cotton test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of cotton test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22489","type":"journal-article","created":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T12:05:26Z","timestamp":1579262726000},"page":"539-545","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["The cotton test redistributes nasal airflow in patients with empty nose syndrome"],"prefix":"10.1002","volume":"10","author":[{"given":"Jennifer","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Thamboo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4484-5123","authenticated-orcid":false,"given":"Sachi","family":"Dholakia","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery Stanford University  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole A.","family":"Borchard","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery Stanford University  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"McGhee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-2423","authenticated-orcid":false,"given":"Chengyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering Villanova University  Villanova PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4805-2689","authenticated-orcid":false,"given":"Kai","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery The Ohio State University  Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head &amp; Neck Surgery Stanford University  Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2009.02.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24813"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21842"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22097"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajr.2007.21.2987"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26769"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26549"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22350"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22045"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/08942680152484199"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21319"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2017.08.031"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26530"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2017.2296"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060517715167"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/10255842.2017.1385779"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016489709113443"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1590\/1982-0216201618111915"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26599"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1945892418816841"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23033"}],"container-title":["International Forum of Allergy &amp; Rhinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Falr.22489","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.22489","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/alr.22489","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/am-pdf\/10.1002\/alr.22489","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alr.22489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T09:21:40Z","timestamp":1694078500000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/alr.22489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,17]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1002\/alr.22489"],"URL":"https:\/\/doi.org\/10.1002\/alr.22489","archive":["Portico"],"relation":{},"ISSN":["2042-6976","2042-6984"],"issn-type":[{"value":"2042-6976","type":"print"},{"value":"2042-6984","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,17]]},"assertion":[{"value":"2019-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}