NOSE

Nasal Airway Obstruction

Introduction: The nasal passages are an indispensable part of the human respiratory system; they play an important role in maintaining the exchange of oxygen and carbon dioxide to the lungs and tissues. The nasal passages are also responsible for filtration of particulate matter (dust, sands, bugs, etc.) from the respiratory tract; and they are vital for smelling and tasting. Function of the nasal airways can be impaired by conditions associated with nasal respiratory airway obstruction, such as inflammatory diseases (allergic rhinitis, sinusitis, etc.) and anatomical abnormalities (septal deviation, nasal valve collapse, cleft nasal deformity, etc.). In cases involving anatomical abnormalities, determining the specific sites of greatest nasal obstruction is exceptionally difficult because there are often multiple sites of airway obstruction; accurate diagnosis is usually challenging because of the presence of concomitant diseases, such as asthma and sleep-related disorder. The consequence of inadequate detection and diagnosis of nasal obstruction is that surgical failure rates for treatment of nasal obstruction are as high as 25-50%. Other factors that may be implicated in this high surgical failure rate include lack of understanding of the pathologic deformity and its extent, as well as the existing lack of consensus relative to treatment. Many, if not most, corrective procedures for nasal obstruction are performed by specialists who have variable expertise in functional nasal anatomy or rhinoplasty surgery.

Project Goal: Our research goal is to increase treatment efficacy for patients with nasal airway obstruction related conditions by developing a computational modeling platform to aid clinicians in optimizing patient-specific treatment outcomes.  Our current objectives, which are next steps in pursuit of the research goal  are [1] to develop an analytical method to identify and evaluate specific anatomic sites of greatest nasal obstruction contributing to difficulty in breathing; [2] to investigate, at a micro level, how well current clinical intervention targets the most relevant sites of nasal obstruction; and [3] to determine, virtually, surgical procedure types to optimize patients’ nasal outcomes, and develop a predictive model that can accurately forecast patient-reported satisfaction for any surgical procedure type that was performed on the patient.

Age-Related Olfactory Dysfunction

Introduction: Although it is commonly recognized that olfactory function diminishes with age, age-related olfactory loss in the absence of underlying neurodegenerative diseases (presbyosmia) has often been classified as idiopathic. The conductive mechanisms of olfaction (i.e. respiratory effort and nasal anatomical structure) are typically given little priority in the evaluation of age-related olfactory loss, notwithstanding that these conductive factors also change with age; their contributions to presbyosmia are poorly understood. Studies have reported evidence of age-related changes in the nasal anatomy, inspiratory pressure, and respiratory muscle strength. Further, variations in nasal structure have traditionally been understood to influence olfaction. Nonetheless, it remains unknown how natural variations in nasal morphology, influenced by age-related structural changes and declining inspiratory pressure, inhibit olfactory function in geriatric subjects. In our 2016 publication, Ramprasad and Frank-Ito  described three distinct normal variations in the human nasal vestibule airspace that had not been previously described in the literature. These morphologies were found across subjects with healthy nasal anatomy and in those with sinonasal disease. At present, it is not clear if these variations are race/ethnicity dependent or associated with aging and/or gender.  Our results suggest that variations in nasal vestibule have significant effects on nasal resistance at the anterior nose. This implies that, while variability in nasal vestibule may not affect overall nasal patency in healthy subjects, local airflow patterns and local resistance at the superior anterior portion of the nose are significant factors influencing odorant-laden air transport to the olfactory recess.

Project Goal: Our research goal is to identify conductive factors that contribute to and predict variability in human olfactory function, which knowledge may be essential in providing insights into certain aspects of loss of smell that are currently considered idiopathic. Our research objective here is to determine how natural variations in conductive factors affect olfaction.