Impact of long-term nasal airflow deprivation on sinonasal structures
and chronic rhinosinusitis
Abstract
Abstract Objectives: Total laryngectomy (TL) patients are good models in
which to evaluate the effects of nasal airflow cessation on the
sinonasal tract. Here, we evaluated changes in sinonasal structures and
association with chronic rhinosinusitis (CRS), in the computed
tomography (CT) images three-year post-TL. Design: Retrospective medical
chart review. Setting: Tertiary referral medical center, teaching
hospital setting. Participants: Data from patients that underwent TL
from 2005–2017 were reviewed retrospectively. Patients with a final
follow-up CT taken less than 3 years after TL, tracheo-esophageal
puncture, inadequate CT image, or history of sinonasal surgery were
excluded. The control group included partial laryngectomy or
hypopharyngectomy patients. Altogether, 45 TL patients and 38 controls
were selected. Main outcome measurements: The volume of all four
paranasal sinuses, inferior turbinate mucosal volume (ITMV), maxillary
sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS)
were measured on preoperative and postoperative CT scans. Results: The
mean duration between surgery and the final CT scan was 6.3±2.4 and
5.5±2.3 years for the TL and control groups, respectively. Neither group
showed significant changes in four paranasal sinuses volume or MSNO
mucosa width. The ITMV decreased significantly, from 4.6±1.3ml to
2.8±1.1ml (p<0.001), in the TL group, whereas the control
group showed no significant changes. Postoperative LMS changes in both
groups were insignificant. The number of patients with LMS aggravation
or alleviation was the same in both groups, regardless of preoperative
CRS. Conclusions: Paranasal sinus structures and CRS are not affected
significantly by nasal airflow cessation; however, the inferior
turbinate mucosa is affected by long-term discontinuation of nasal
airflow.