Conductive olfactory losses in chronic rhinosinusitis? A computational fluid dynamics study of 29 patients.
Conductive olfactory losses in chronic rhinosinusitis? A computational fluid dynamics study of 29 patients.
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DOI：
10.1002/alr.21272
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发表时间：
2014-04
影响因子：
6.4
通讯作者：
Cowart, Beverly J.
中科院分区：
文献类型：
--
作者：
Zhao, Kai;Jiang, Jianbo;Pribitkin, Edmund A.;Dalton, Pamela;Rosen, David;Lyman, Brian;Yee, Karen K.;Rawson, Nancy E.;Cowart, Beverly J.
关键词：
除了感音神经因素外，传导障碍也可能导致慢性鼻窦炎（CRS）患者的嗅觉丧失，但尚无确凿的证据。我们的目的是使用计算流体动力学 (CFD) 模型检查可能的传导因素。通过气味检测阈值 (ODT)、鼻压测量（鼻阻力：NR）、声学鼻测量（最小横截面积：MCA）和 CT 分期对 29 名 CRS 患者进行了评估。基于个体 CT 进行鼻腔气流和嗅觉区域气味吸收的 CFD 模拟。收集嗅上皮 (OE) 活组织检查、冷冻切片、染色并进行侵蚀评分。三个变量与 ODT 显着相关：嗅觉区域的气味吸收（r=-0.60，p<0.01）、MCA（r=-0.40，p<0.05）和 CT 分期（r=0.42，p<0.05）。然而，重要的发现仅限于高度可溶的左旋香芹酮的 ODT。多元回归分析表明，这些变量加上 NR，可以解释 ODT 总方差的 65%。 CT 分期与 OE 侵蚀显着相关（r=0.77，p<0.01），并且可以在具有可比结果的回归中替代后者。偏相关表明，如果根据另一个变量的影响进行调整，传导变量和感音神经变量的贡献会更加突出。嗅觉丧失和炎症因子双侧均有较强的参与性，而传导性因素则两侧独立。作为验证，CFD 模拟的 NR 与鼻压评估的 NR 显着相关（r=0.60，p<0.01）。传导机制和感音神经机制都会导致 CRS 中的嗅觉丧失。 CFD 建模为理解 CRS 嗅觉功能障碍中传导障碍的作用提供了重要指导。
Besides sensorineural factors, conductive impediments likely contribute to olfactory losses in chronic rhinosinusitis (CRS) patients, yet no conclusive evidence exists. We aimed to examine possible conductive factors using computational fluid dynamics (CFD) models. 29 CRS patients were assessed via odorant detection thresholds (ODTs), rhinomanometry (nasal resistance: NR), acoustic rhinometry (minimum-cross-sectional area: MCA) and CT staging. CFD simulations of nasal airflow and odorant absorption to olfactory region were carried out based on individual CTs. Biopsies of olfactory epithelium (OE) were collected, cryo-sectioned, stained and scored for erosion. Significant correlations to ODTs were found for three variables: odor absorption in the olfactory region (r=−0.60, p<0.01), MCA (r=−0.40, p<0.05) and CT staging (r=0.42, p<0.05). However, significant findings were limited to ODTs of the highly soluble l-carvone. Multiple regression analysis revealed that these variables combined, with the addition of NR, can account for 65% of the total variance in ODTs. CT staging correlated significantly with OE erosion (r=0.77, p<0.01) and can replace the latter in the regression with comparable outcomes. Partial correlations suggest the contributions of both conductive and sensorineural variables are more prominent if adjusted for the effects of the other. Olfactory loss and inflammatory factors have strong bilateral involvement, while conductive factors are independent between sides. As validation, CFD-simulated NRs significantly correlated with rhinomanometrically assessed ones (r=0.60, p<0.01). Both conductive and sensorineural mechanisms can contribute to olfactory losses in CRS. CFD modeling provides critical guidance in understanding the role of conductive impediments in olfactory dysfunction in CRS.
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