{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:16:42Z","timestamp":1792271802822,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T00:00:00Z","timestamp":1573516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Patients are frequently advised to sneeze with an open mouth and avoid nose\u2010blowing following an endoscopic endonasal approache (EEA) to the skull base, despite a lack of quantitative evidence. This study applies computational fluid dynamics (CFD) to quantify sinus pressures along the skull base during sneezing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case\u2013control series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Computed tomography or magnetic resonance imaging scans of four post\u2010EEA patients and four healthy controls were collected and analyzed utilizing CFD techniques. A pressure drop of 6,000 Pa was applied to the nasopharynx based on values in the literature to simulate expiratory nasal airflow during sneezing. Peak pressures along the skull base in frontal, ethmoid, and sphenoid sinuses were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant increases in skull base peak pressure was observed during sneezing, with significant individual variations from 2,185 to 5,685 Pa. Interestingly, healthy controls had significantly higher pressures compared to post\u2010EEA patients (5179.37\u2009\u00b1\u2009198.42 Pa vs. patients 3,347.82\u2009\u00b1\u20091,472.20 Pa, <jats:italic>P<\/jats:italic> &lt;\u2009.05), which could be related to higher anterior nasal resistance in unoperated healthy controls (0.44\u2009\u00b1\u20090.22 vs. 0.31\u2009\u00b1\u20090.16 Pa\/mL\/sec for patients, <jats:italic>P<\/jats:italic> =\u2009.38). The sinus pressure buildup may be due to airway resistance functioning as a valve preventing air from being released quickly. Supporting this theory, there was a strong correlation (<jats:italic>r<\/jats:italic> =\u20090.82) between peak skull base pressure and the ratio of anterior resistance to total resistance. Within\u2010subject variation in pressures between different skull base regions was much lower (average = ~5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provided the first quantitative analysis of air pressure along the skull base during sneezing in post\u2010EEA patients through CFD, suggesting that pressure buildup may depend on individual anatomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3b <jats:italic>Laryngoscope<\/jats:italic>, 130:2138\u20132143, 2020<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28400","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T16:19:27Z","timestamp":1573575567000},"page":"2138-2143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Peak Sinus Pressures During Sneezing in Healthy Controls and Post\u2013Skull Base Surgery Patients"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7585-4914","authenticated-orcid":false,"given":"Zhenxing","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7377-4782","authenticated-orcid":false,"given":"John R.","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Henry Ford Health System  Detroit Michigan U.S.A."}],"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\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Farag","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo L.","family":"Carrau","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"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\u2013Head and Neck Surgery The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-211-72283-1_4"},{"key":"e_1_2_6_3_1","first-page":"1","article-title":"Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations","volume":"19","author":"Cavallo LM","year":"2005","journal-title":"Neurosurg Focus"},{"key":"e_1_2_6_4_1","first-page":"E4","article-title":"Expanded endonasal approach: the rostrocaudal axis. 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