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This article discusses the rhinological applications of computational fluid dynamics (CFD) – a method derived from engineering applications, such as aerodynamics. Its appeal is that it can provide simulated data on airflow velocity, pressure, resistance, temperature, humidity, heat flux and wall shear stress from different areas within the nasal cavity. The authors describe how this has been used to map the normal physiology of sinonasal airflow, responses of sinonasal airflow to surgical interventions, and distribution of nasal medications in the nose and sinuses. These studies have raised some questions in response to conventional practices, such as head positioning during sinus irrigation, and ‘one size fits all’ nasal airway procedures. ‘Virtual surgery’ packages are highlighted, where CT scans can be used to generate a CFD report before and after simulated surgical modifications to the nasal airway. Reading this article, it seemed to me that this could be a useful approach for delivering more individualised care to patients, for medication delivery techniques and particularly for the challenge of deciding whether a nasal airway procedure is warranted. However, in light of the discord between rhinometry and nasal symptom improvement, it is notable that correlation with patient-reported outcome measures is not discussed in this article. Such data would be necessary to demonstrate that this technique is of practical, as well as a theoretical, benefit for patients.

Can computational fluid dynamic models help us in the treatment of chronic rhinosinusitis?
Singh NP, Inthavong K.
Curr Opin Otolaryngol Head Neck Surg
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Matthew Coates

Freeman Hospital, Newcastle-Upon-Tyne, UK.

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