International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30927405 Local corticosteroids, why are they not used more / properly ? 81 81 EN W.J. Fokkens Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, The Netherlands 1883 10.4193/Rhin19.402 It has been almost 50 years since Niels Mygind published the first paper on the use of nasal corticosteroids. Twenty years ago, Weiner et al. showed in their systematic review that nasal corticosteroids are more effective than oral antihistamines in patients with allergic rhinitis. Over 3000 papers later, all showing the efficacy and superiority of local corticosteroids over most other treatment options available in rhinitis and chronic rhinosinusitis (CRS); we still have not been able to convince the public and our colleagues that most patients with rhinitis/rhinosinusitis would significantly benefit from the use of a local corticosteroid.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30471226 Clinical efficacy of intranasal drug delivery by nebulization in chronic rhinosinusitis: a systematic review 82 93 EN Gregory Reychler Institut de Recherche Experimentale et Clinique (IREC), Pole de Pneumologie, ORL and Dermatologie, Universite Catholique de Louvain, Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium; Haute Ecole Leonard de Claire Domachowski Haute Ecole Leonard de Vinci â€" Institut d’Enseignement Superieur Parnasse-Deux Alice, Brussels, Belgium Anne-Claire Latiers Service de Medecine Physique et Readaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium; Service de Medecine Nucleaire, Cliniques universitaires Saint-Luc, Brussels, Belgium Francois Jamar Service de Medecine Nucleaire, Cliniques universitaires Saint-Luc, Brussels, Belgium Philippe Rombaux Service d’Oto-rhino-laryngologie, Cliniques universitaires Saint-Luc, Brussels, Belgium 1855 10.4193/Rhin18.010 BACKGROUND: Treatment of chronic rhinosinusitis (CRS) aims to treat the underlying inflammation or infection. Although the optimal modality of administration remains controversial, inhalation route is usually preferred. The aim of this systematic review was to summarize the efficacy of intranasal corticoisteroids or antibiotics delivery by nebulization on symptoms, histology, endoscopy scores, nasal obstruction, clinical outcomes and quality of life in CRS. METHOD: This systematic review followed the PRISMA guidelines. Randomized controlled, comparative and cohort studies evaluating effects of treatment by nebulization in sinusitis were identified and reviewed from two databases (PubMed and Scopus). Two reviewers independently assessed study quality and reviewed the selected studies. RESULTS: 600 references were retrieved and 12 studies evaluating 377 patients were included in the systematic review. Different devices were used. Efficacy of nasal delivery by nebulization was systematically observed on symptoms and size of polyps and frequently on inflammatory parameters in all studies. The presence of polyps improved the efficacy of the nebulization. This way of delivery appears not convincing regarding antibiotics. Few side effects were noted in the retrieved studies and only for nebulized antibiotics. CONCLUSIONS: This systematic review highlighted that based on the present literature nebulization is not better than nasal spray to the delivery of corticosteroids due to the positive results on symptoms, endoscopic appearance and histological outcomes. For antibiotics delivery, the nebulization is not of added value.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30076702 Medication use in patients with chronic rhinosinusitis in Germany - a large retrospective patient-based study 94 100 EN J.J.H. Park Department of Otorhinolaryngology and Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany D.U. Seidel Department of Otorhinolaryngology, Head and Neck Surgery, Solingen Municipal Hospital, Solingen, Germany C. Bachert Upper Airways Research Laboratory and ENT-Department, Ghent University Hospital, Ghent, Belgium S. Dazert Department of Otorhinolaryngology and Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany K. Kostev Epidemiology, IQVIA, Frankfurt, Germany 1833 10.4193/Rhin18.055 BACKGROUND: The aim of the present study was to provide an insight into medical treatment practices among patients with chronic rhinosinusitis (CRS) in Germany. An investigation of ICD codes and ATC classes of CRS patients in general and otolaryngology offices in Germany should reveal the prevalent treatment behaviors of German physicians. METHODS: The present study used data from the Disease Analyzer database (IQVIA). The study sample included patients from 940 general (GP) and 106 otolaryngology (ENT) practices who were coded as having chronic sinusitis (ICD-10: J32) or nasal polyps (ICD-10: J33) in 2015 (index date). The primary outcome measures were the number of patients with these diagnoses per practice as well as the proportion of patients with prescriptions for topical corticosteroids, systemic corticosteroids, antibiotics, antihistamines, and local decongestants within 365 days after the first diagnosis. RESULTS: This retrospective study included 26,768 patients with coding for chronic sinusitis (ICD-10: J32) and 516 patients for nasal polyps (ICD-10: J33) in 940 GP practices and 19,826 patients with coding for chronic sinusitis (ICD-10: J32) and 1,773 patients for nasal polyps (ICD-10: J33) in 106 ENT practices. In patients coded as having chronic sinusitis (ICD-10: J32), topical corticosteroids were prescribed at a low rate (GP: 12.3%, ENT: 34.3%). In patients coded as having nasal polyps (ICD-10: J33), topical corticosteroid usage was higher in GP practices (27.3%) and in ENT practices (71.2%). CONCLUSIONS: Topical corticosteroid usage in CRS patients in GP practices in Germany is as low as in other Western countries. Increased usage of topical corticosteroids in CRS patients with polyposis should be encouraged in GP and ENT practices.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 Comparison of efficacy of fluticasone propionate versus clarithromycin for postoperative treatment of different phenotypic chronic rhinosinusitis: a randomized controlled trial 101 109 EN M. Zeng Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China H. Wang Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China B. Liao Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China H. Wang Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China X.B. Long Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China J. Ma Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China J.X. Liu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China P.P. Cao Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Q Ning Department of Infectious Disease, Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Z. Liu Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 1837 10.4193/Rhin17.226 BACKGROUND: Chronic rhinosinusitis (CRS) can be divided to CRS without nasal polyps (CRSsNP) and eosinophilic and non-eosinophilic CRS with nasal polyps (CRSwNP). There is little evidence on the efficacy of glucocorticoids and macrolides in different phenotypic patients. The aim of this study was to compare the benefit of glucocorticoids and macrolides following endoscopic sinus surgery (ESS) in different phenotypic CRS. METHODS: This study was a prospective single-blind comparative effectiveness trial. A total of 187 Chinese patients with CRS were stratified to CRSsNP and eosinophilic and non-eosinophilic CRSwNP group and then randomized to receive fluticasone propionate nasal spray at 200 microgram or clarithromycin tablet at 250 mg once daily for 3 months after ESS. Oral prednisone was given as a rescue therapy after the stop of study medication. Patients were assessed before ESS and 1, 3, 6 and 12 months after dosing. Symptom severity was scored by patients using visual analog scale method and endoscopic findings were scored by the senior physician blinded to treatment according to European Position Paper on Rhinosinusitis and Nasal polyps 2012. RESULTS: The total and individual symptom scores, and total and individual endoscopic domain scores were reduced significantly after ESS in both medication groups, whereas no significant difference was observed for two medications at most follow-up visits in each subtype of CRS. No difference in the frequency of subjects with rescue therapy or refractory CRS was found between two medication groups either. CONCLUSIONS: We could not show significant difference of effect between fluticasone propionate and clarithromycin in the post-operative treatment for CRSsNP and eosinophilic and non-eosinophilic CRSwNP patients.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30175337 Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis 110 116 EN L.P. Hoehle Department of Otolaryngology, Harvard Medical School, Boston, MA, USA K.M. Phillips Department of Otolaryngology, Harvard Medical School, Boston, MA, USA M.M. Speth Klinik fur Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland D.S. Caradonna Department of Otolaryngology, Harvard Medical School, Boston, MA, USA S.T. Gray Department of Otolaryngology, Harvard Medical School, Boston, MA, USA A.R. Sedaghat Department of Otolaryngology, Harvard Medical School, Boston, MA, USA 1839 10.4193/Rhin18.122 BACKGROUND: The 5-dimensional EuroQol questionnaire (EQ-5D) is validated to measure general health-related quality of life (QOL). Our objective was to determine the responsiveness and minimal clinically important difference (MCID) of the EQ-5D health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS) in chronic rhinosinusitis (CRS). METHODS: 203 adults undergoing medical management for CRS were prospectively recruited. General health-related QOL (using EQ-5D HUV and EQ-5D VAS) and CRS-specific QOL (using the 22-item Sinonasal Outcome Test [SNOT-22]) were measured at enrollment and a subsequent follow-up time point 2-12 months later. At follow-up, participants also rated change in general health as Much worse, A little worse, About the same, A little better or Much better compared to enrollment. The EQ-5D HUV and EQ-5D VAS MCIDs were calculated using distribution-based, anchor-based, and receiver operator characteristic (ROC) curve-based methods. RESULTS: Change in SNOT-22 score was correlated with EQ-5D HUV and EQ-5D VAS change. Using the different methods of calculating MCID, we find the EQ-5D HUV MCID to be 0.04 and EQ-5D VAS MCID to be 8.0. The calculated EQ-5D MCIDs had approximately a sensitivity of 40-50% and specificity of 80% in detecting patients experiencing noticeable improvement in general health. CONCLUSIONS: The EQ-5D responds well to changing CRS symptomatology. We propose MCIDs for EQ-5D HUV of 0.04 and EQ-5D VAS of 8 in CRS patients, which although specific, are not sensitive for detecting patients experiencing improvement in general health.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30352446 Radiologic changes in the aging nasal cavity 117 124 EN Kimia G. Ganjaei Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC; Rutgers Robert Wood Johnson Medical School, Piscataway, NJ United States Zachary M. Soler Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Elliott D. Mappus Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Mitchell L. Worley Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Nicholas R. Rowan Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Guilherme J.M. Garcia Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States Lois J. Matthews Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Judy R. Dubno Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Mark A. Eckert Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States Rodney J. Schlosser Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC United States 1847 10.4193/Rhin18.096 BACKGROUND: With an aging population, it is important to understand age-related anatomic changes in the nasal cavity and cribriform plate (CP) that may have clinical implications. METHODOLOGY: Computed tomography (CT) scans obtained for non-rhinologic conditions were divided into a young cohort (N=35, 18-34 years old) and an older adult cohort (N=32, 80-99 years old). Intranasal airspace volumes and bony anatomy of the CP were manually segmented using OsiriX software. The CP was assessed for mean Hounsfield Units (HU) and percentage of olfactory foramina. Deformation based morphometry (DBM) was then performed on the same cohort and correlated with manual measurements. RESULTS: Individual nasal cavity volumes increased 17-75% with age. Regression analysis of all scans revealed age to be the predominant variable influencing intranasal volume differences when controlling for sex and head size. Mean HU of the CP negatively correlated with age. No age-related differences in bone stenosis of olfactory foramina were identified. Automated DBM measurements of intranasal volumes, as well as CP and zygoma mean HU correlated with manual measurements. CONCLUSION: Older subjects have a global increase in intranasal volumes and diffuse bone density loss in the CP. The clinical impact of age-related anatomic changes in the nasal cavity and CP requires further investigation.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30364918 Propofol sedation in Drug Induced Sedation Endoscopy without an anaesthesiologist â€" a study of safety and feasibility 125 131 EN E. Kirkegaard Kiaer Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark P. Tonnesen Danish Institute for Sleep Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark H.B. Sorensen Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark N. Rubek Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark A. Hammering Department of Anesthesiology, Gentofte Hospital, Copenhagen, Denmark C. Moller Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark A.M. Hildebrandt Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark P.J. Jennum Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark C. von Buchwald Department of ORL, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark 1848 10.4193/Rhin18.066 BACKGROUND: Propofol sedation in Drug Induced Sedation Endoscopy (DISE) of the upper airway of patients with obstructive sleep apnea (OSA) without the presence of anesthesiologist has not been done before. Propofol sedation is normally administered by an anesthesiologist. This is the first study of this new method. METHODOLOGY: Based on the positive experience with Nurse-administered Propofol Sedation (NAPS) for endoscopic procedures in the departments of gastroenterology we wanted to test the set-up as method of propofol sedation for DISE procedures in our Otorhinolaryngology (ORL) department. The ORL specialists and staff nurses that carry out DISE procedures all underwent a formalized education in Nurse-administered Propofol Sedation before the study. We included 200 patients with severe snoring and / or obstructive sleep apnea. They were referred for DISE examination prior to possible targeted surgery based on the findings. RESULTS: In our study the aforementioned ORL team successfully cared out propofol sedation without the presence of an anesthesiologist. All examinations were carried out according to plan. There were no adverse events during the procedures or in the following observational period. CONCLUSIONS: The NAPS method of sedation for DISE seems safe and feasible when performed by trained staff in a hospital setting.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30471227 Similar survival outcome after endoscopic and open approaches for sinonasal mucosal melanoma 132 138 EN M. Lundberg Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland A. Haapaniemi Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland J. Hagstrom Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland S. Juteau Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland M. Hernberg Department of Oncology, Comprehensive Cancer Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland A.A. Makitie Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolin S.I. Vento Department of Otorhinolaryngology â€" Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 1854 10.4193/Rhin18.123 BACKGROUND: To describe a cohort of sinonasal mucosal melanoma (SNMM) patients, and to assess if choice of surgical approach (open versus endoscopic) has impact on survival. METHODOLOGY: Adequate data on clinical presentation, treatment, and recurrence pattern were available for 58 consecutive patients treated for SNMM at the Helsinki University Hospital (HUH) between 1983 and 2016. RESULTS: The 5-year disease-specific survival (DSS) was 27% and overall survival 25% for the whole cohort. The 3-year DSS for patients treated with curative intent with endoscopic surgery was comparable to open surgery (56% and 51%, respectively). Patients with tumours arising from the paranasal sinuses and patients with Stage IV disease had significantly worse prognosis compared with other locations and Stage III patients. All patients who had disease persistence at three months after primary treatment succumbed to SNMM. Post-operative radiotherapy did not affect survival significantly, but a trend towards improved local control was observed. CONCLUSIONS: Local control after endoscopic surgery was comparable to open surgery. Small tumours without local or locoregional spread had improved prognosis, independent of surgical approach. Disease persistence after treatment with curative intent led to death invariably.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30471225 Lack of correlation between serum 25(OH)D level and endoscopy-based chronic rhinosinusitis in Korean adults 139 146 EN Eun Jung Lee Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea; The Centre for Personalised Medicine and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linkoping, Sweden Chi Sang Hwang Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, Wonju, Korea Kyung-Su Kim Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea 1853 10.4193/Rhin18.110 BACKGROUND: Several previous studies have shown that serum 25(OH)D deficiency is associated with increased risk of chronic rhinosinusitis (CRS) in adults and also correlated with disease severity. We aimed to investigate the correlation between serum 25(OH)D level and endoscopy-based CRS in adults using the Korean National Health and Nutrition Examination Survey. METHODS: The data were based on the Korean National Health and Nutrition Examination Survey from 2008 to 2011. Diagnosis of endoscopy-based CRS was based on endoscopic findings of mucopurulent rhinorrhea in the middle meatus or nasal polyps, with nasal symptoms satisfying symptom-based CRS based on European Position Paper on Rhinosinusitis and Nasal Polyps 2012 criteria. Nasal symptoms included nasal obstruction, anterior/posterior nasal drip, facial pain, and the loss of smell. Serum 25(OH) D level was defined as deficient (less than 20 ng/mL), insufficient (20â€"29.9 ng/mL), or sufficient (less than or equal to 30 ng/mL). RESULTS: The serum 25(OH)D level in the CRS group was 19.293 'plus or minus' 7.035 ng/mL, which was higher than that of the control group (18.057 'plus or minus' 6.56 ng/mL, p = 0.0072). Among symptom combinations of endoscopy-based CRS, some combinations with mucopurulent rhinorrhea at the middle meatus were significantly related to normal serum 25(OH)D level. CONCLUSION: Low serum 25(OH)D level might not be associated with increased prevalence of CRS in Korean adults; rather, patients with CRS showed higher serum 25(OH)D levels than the control group. Thus, these results, contradicting those of previous studies, should be further verified in other countries to investigate the role of the serum 25(OH)D in CRS.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30489573 Topographical distribution of trigeminal receptor expression in the nasal cavity 147 152 EN Sophia C. Poletti Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Tuebingen, Tuebingen, Germany Jacqueline Hausold Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Department of Gynecology, TU Dresden, Dresden, Germany Andreas Herrmann Department of Neurology, TU Dresden, Dresden, Germany Martin Witt Institute of Anatomy, Rostock University Medical Center, Rostock, Germany Thomas Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany 1856 10.4193/Rhin18.181 BACKGROUND: Topographical differences in trigeminal receptor distribution of the nasal cavity has been investigated so far indirectly using various agonists to stimulate receptors in different locations. However, polymodal activation of trigeminal receptors poses difficulties in such investigation. The aim of our study was to examine the distribution of trigeminal receptor mRNA expression using quantitative PCR. METHODOLOGY: A prospective study was performed in 18 healthy volunteers. Mucosal biopsies were obtained from five different endonasal locations (covering the anterior, posterior and lateral nasal cavity) for receptor mRNA quantification by means of RTPCR. RESULTS: The highest overall level of RNA expression was found for TRPV1, followed by ACCN3, TRPA1 and TRPM8. Identical distribution pattern could be shown for each investigated area of the nasal cavity. Highest overall receptor density was found in the posterior septum due to high TRPV1 and ACCN3 receptor expression. CONCLUSIONS: For the first time, we demonstrate a distinct trigeminal receptor RNA distribution pattern of the nasal mucosa. The highest overall distribution level was found in the posterior nose.

International Rhinologic Society Rhinology 0300-0729 57 2 2019 4 1 30693353 A computational fluid dynamics analysis of the effects of size and shape of anterior nasal septal perforations 153 159 EN Z. Farzal Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA A.G. Del Signore Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, USA A.M. Zanation Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA C.S. Ebert, Jr. Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA D. Frank-Ito Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Computational Biology and Bioinformatics Program, Duke University, Durham, NC, USA; Department of Mechanical Engineering J.S. Kimbell Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA B.A. Senior Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA 1874 10.4193/Rhin18.111 BACKGROUND: Nasal septal perforations (NSPs) often cause bleeding, crusting, obstruction, and/or whistling. The objective was to analyze the impact of anterior NSP size and shape on nasal physiology using computational fluid dynamics (CFD). METHODS: A 3-dimensional model of the nasal cavity was constructed from a radiologically normal CT scan using imaging software. Anterior NSPs (ovoid (ONSP): 0.5, 1, 2, and 3 cm long anterior-to-posteriorly and round (RNSP, 0.5 and 1 cm)) were virtually created in the model and divided into ventral, dorsal, anterior, and posterior regions. Steady-state inspiratory airflow, heat, and water vapor transport were simulated using Fluentâ„¢ CFD software. Air crossover through the perforation, wall shear, heat flux, water vapor flux, resistance, and humidification were analyzed. RESULTS: Air crossover and wall shear increased with perforation size. Regionally, wall shear and heat and water vapor flux were highest posteriorly and lowest anteriorly, generally increasing with size in those regions. RNSPs had greater heat and water vapor flux compared to corresponding size ONSPs. Resistance decreased by 10% or more from normal only in the 3 cm ONSP. Maximum water content was achieved more posteriorly in larger NSP nasal cavities. CONCLUSIONS: High wall shear and heat and water vapor flux in posterior perforation regions may explain the crusting most commonly noted on posterior NSP edges. This preliminary study suggests that larger NSPs have a greater effect on nasal resistance and water content. Decrease in resistance with larger NSP size may be implicated in reported symptomatic improvement following enlargement of NSPs for treatment.