Nasal air conditioning (ie, heating and humidification of inspired air) is an important function of the nasal cavity. This function may be reduced in cases of aggressive nasal surgery. Future virtual surgery planning tools may be used to design surgical approaches that preserve the nasal air conditioning capacity while decreasing airflow resistance. However, it is unclear whether there is a threshold below which impaired nasal air conditioning is associated with negative health consequences.
Objective
This study aims to review the literature on the clinical impact of reduced nasal air conditioning and its implications for nasal surgery outcomes.
Methods
A literature search was performed on PubMed and Scopus databases for articles that investigated the effect of air temperature and humidity on mucociliary clearance, respiratory epithelial structure, and the prevalence and severity of respiratory diseases.
Results
Inspiration of cold, dry air has direct effects on the respiratory epithelium, such as reduced mucociliary clearance and loss of cilia. Nasal surgeries do inflict some changes to the nasal mucosa and geometry that may result in decreased heating and humidification, but it is unclear how long these effects last. Laryngectomy patients serve as a human model for the absence of nasal air conditioning. The heat and moisture exchangers that many laryngectomy patients wear have been shown to improve lung function and reduce pulmonary symptoms associated with breathing unconditioned air, such as increased coughing and thickened mucus.
Conclusion
Nasal air conditioning is an important mechanism to maintain mucociliary clearance and prevent infection by inhaled pathogens. Preservation of nasal air conditioning capacity should be considered in the implementation of future virtual surgery planning tools. However, a threshold for the onset of negative health consequences due to impaired nasal air conditioning is not yet available.
KuanECSuhJDWangMB.Empty nose syndrome.Curr Allergy Asthma Rep. 2015;
15:493.
2.
ChambersKJHorstkotteKAShanleyK, et al.
Evaluation of improvement in nasal obstruction following nasal valve correction in patients with a history of failed septoplasty.JAMA Facial Plast Surg. 2015;
17:347–350.
3.
BohlinLDahlqvistA.Nasal airway resistance and complications following functional septoplasty: a ten-year follow-up study.Rhinology. 1994;
32:195–197.
4.
VanhilleDLGarciaGJMAsanO, et al.
Virtual surgery for the nasal airway: a preliminary report on decision support and technology acceptance.JAMA Facial Plast Surg. 2018;
20:63–69.
5.
Sanmiguel-RojasEBurgosMAEsteban-OrtegaF.Nasal surgery handled by CFD tools.Int J Numer Method Biomed Eng. 2018;
34:e3126.
6.
QuammenCWTaylorRM IIKrajcevskiP, et al.
The virtual pediatric airways workbench. Stud Health Technol Inform. 2016;
220:295–300.
7.
StankeF.The contribution of the airway epithelial cell to host defense.Mediators Inflamm. 2015;
2015:463016.
8.
WolfMNaftaliSSchroterRC, et al.
Air-conditioning characteristics of the human nose.J Laryngol Otol. 2004;
118:87–92.
9.
WilliamsRRankinNSmithT, et al.
Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa.Crit Care Med. 1996;
24:1920–1929.
10.
NadelJADavisBPhippsRJ.Control of mucus secretion and ion transport in airways.Annu Rev Physiol. 1979;
41:369–381.
11.
MatsuiHRandellSHPerettiSW, et al.
Coordinated clearance of periciliary liquid and mucus from airway surfaces.J Clin Invest. 1998;
102:1125–1131.
12.
EladDWolfMKeckT.Air-conditioning in the human nasal cavity.Respir Physiol Neurobiol. 2008;
163:121–127.
13.
NaftaliSRosenfeldMWolfM, et al.
The air-conditioning capacity of the human nose.Ann Biomed Eng. 2005;
33:545–553.
14.
WebbP.Air temperatures in respiratory tracts of resting subjects in cold.J Appl Physiol. 1951;
4:378–382.
15.
IngelstedtS.Studies on the conditioning of air in the respiratory tract.Acta Otolaryngol Suppl. 1956;
131:1–80.
16.
ColeP.Some aspects of temperature, moisture and heat relationships in the upper respiratory tract.J Laryngol Otol. 1953;
67:449–456.
17.
DayalARheeJSGarciaGJ.Impact of middle versus inferior total turbinectomy on nasal aerodynamics.Otolaryngol Head Neck Surg. 2016;
155:518–525.
18.
IngelstedtSIvstamB.Study in the humidifying capacity of the nose.Acta Otolaryngol. 1951;
39:286–290.
19.
MogensenCTosM.Experimental surgery on the nose. I. Airflow and goblet-cell density.Acta Otolaryngol. 1978;
86:289–297.
20.
TosMMogensenC.Density of mucous glands in the normal adult nasal septum.Arch Otorhinolaryngol. 1976;
214:125–133.
21.
TosMMogensenC.Experimental surgery on the nose. Changes of the epithelium in the vestibular region at altered airflow. Acta Otolaryngol. 1979;
87:317–323.
22.
HildingA.Experimental surgery of the nose and the sinuses. Arch Otolaryngol. 1932;
16:9–18.
23.
YoungA.Closure of the nostrils in atrophic rhinitis.J Laryngol Otol. 1971;
85:715–718.
24.
YoungA.Closure of the nostrils in atrophic rhinitis.J Laryngol Otol. 1967;
81:515–524.
25.
MerckeU.The influence of varying air humidity on mucociliary activity.Acta Otolaryngol. 1975;
79:133–139.
26.
KilburnKH.A hypothesis for pulmonary clearance and its implications.Am Rev Respir Dis. 1968;
98:449–463.
27.
HirschJATokayerJLRobinsonMJ, et al.
Effects of dry air and subsequent humidification on tracheal mucous velocity in dogs. J Appl Physiol. 1975;
39:242–246.
28.
GreenASmallmanLALoganAC, et al.
The effect of temperature on nasal ciliary beat frequency.Clin Otolaryngol Allied Sci. 1995;
20:178–180.
29.
TsakiropoulouEVitalVConstantinidisJ, et al.
Nasal air-conditioning after partial turbinectomy: myths versus facts.Am J Rhinol Allergy. 2015;
29:e59–e62.
30.
WiesmillerKKeckTRettingerG, et al.
Nasal air conditioning in patients before and after septoplasty with bilateral turbinoplasty.Laryngoscope. 2006;
116:890–894.
31.
ChenXBLeeHPChongVF, et al.
Numerical simulation of the effects of inferior turbinate surgery on nasal airway heating capacity.Am J Rhinol Allergy. 2010;
24:e118–e122.
32.
NaYChungKSChungSK, et al.
Effects of single-sided inferior turbinectomy on nasal function and airflow characteristics.Respir Physiol Neurobiol. 2012;
180:289–297.
33.
LindemannJKeckTWiesmillerKM, et al.
Numerical simulation of intranasal air flow and temperature after resection of the turbinates.Rhinology. 2005;
43:24–28.
34.
LindemannJLeiackerRSikoraT, et al.
Impact of unilateral sinus surgery with resection of the turbinates by means of midfacial degloving on nasal air conditioning.Laryngoscope. 2002;
112:2062–2066.
35.
KhalmuratovaRJeonSYKimDW, et al.
Wound healing of nasal mucosa in a rat.Am J Rhinol Allergy. 2009;
23:e33–e37.
36.
OzdemirSCelikHCengizC, et al.
Histopathological effects of septoplasty techniques on nasal septum mucosa: an experimental study.Eur Arch Otorhinolaryngol. 2019;
276:421–427.
37.
AtespareAUstundagEDalcikH, et al.
Mucociliary transport and histopathological changes in rotation flaps of the nasal mucosa. Eur Arch Otorhinolaryngol. 2015;
272:1143–1148.
38.
GrutzenmacherSMlynskiRLangC, et al.
The nasal airflow in noses with septal perforation: a model study.ORL J Otorhinolaryngol Relat Spec. 2005;
67:142–147.
39.
CannonDEFrankDOKimbellJS, et al.
Modeling nasal physiology changes due to septal perforations.Otolaryngol Head Neck Surg. 2013;
148:513–518.
40.
NomuraTUshioMKondoK, et al.
Effects of nasal septum perforation repair surgery on three-dimensional airflow: an evaluation using computational fluid dynamics.Eur Arch Otorhinolaryngol. 2015;
272:3327–3333.
41.
LindemannJKuhnemannSStehmerV, et al.
Temperature and humidity profile of the anterior nasal airways of patients with nasal septal perforation.Rhinology. 2001;
39:202–206.
42.
GarciaGJBailieNMartinsDA, et al.
Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity.J Appl Physiol (1985)2007;
103:1082–1092.
43.
TarranRButtonBBoucherRC.Regulation of normal and cystic fibrosis airway surface liquid volume by phasic shear stress.Annu Rev Physiol. 2006;
68:543–561.
44.
HilgersFJAckerstaffAHAaronsonNK, et al.
Physical and psychosocial consequences of total laryngectomy.Clin Otolaryngol Allied Sci. 1990;
15:421–425.
45.
FonkalsrudEWSanchezMHigashijimaI, et al.
A comparative study of the effects of dry vs. humidified ventilation on canine lungs.Surgery. 1975;
78:373–380.
46.
ForbesAR.Temperature, humidity and mucus flow in the intubated trachea.Br J Anaesth. 1974;
46:29–34.
47.
MarfatiaSDonahoePKHendrenWH.Effect of dry and humidified gases on the respiratory epithelium in rabbits.J Pediatr Surg. 1975;
10:583–592.
48.
LorenzKJMaierH. [
Pulmonary rehabilitation after total laryngectomy using a heat and moisture exchanger (HME)].Laryngorhinootologie. 2009;
88:513–522.
49.
MerolJCCharpiotALangagneT, et al.
Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: external humidifier versus heat and moisture exchanger.Laryngoscope. 2012;
122:275–281.
50.
ParrillaCMinniABogaardtH, et al.
Pulmonary rehabilitation after total laryngectomy: a multicenter time-series clinical trial evaluating the Provox XtraHME in HME-naive patients.Ann Otol Rhinol Laryngol. 2015;
124:706–713.
51.
van den BoerCMullerSHvan der NoortV, et al.
Effects of heat and moisture exchangers on tracheal mucociliary clearance in laryngectomized patients: a multi-center case-control study.Eur Arch Otorhinolaryngol. 2015;
272:3439–3450.
52.
BienSOklaSvan As-BrooksCJ, et al.
The effect of a heat and moisture exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study.Eur Arch Otorhinolaryngol. 2010;
267:429–435.
53.
WongCYShakirAAFarboudA, et al.
Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature.Clin Otolaryngol. 2016;
41:646–651.
54.
SesterhennAMFiedlerGMullerHH, et al.
Incidence of sinunasal disease in laryngectomized patients.ORL J Otorhinolaryngol Relat Spec. 2008;
70:185–188.
55.
DixonFWHoerrNLMcCJ.The nasal mucosa in the laryngectomized patients. Ann Otol Rhinol Laryngol. 1949;
58:535–547.
56.
BoyceJEcclesR.Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review.Clin Otolaryngol. 2006;
31:15–19.
57.
SimpsonRE.Discussion on the common cold.Proc R Soc Med. 1958;
51:267–271.
58.
MakinenTMJuvonenRJokelainenJ, et al.
Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections.Respir Med. 2009;
103:456–462.
