The sensation of nasal obstruction in chronic rhinosinusitis: Involvement of the intranasal trigeminal system
Fri-P2-111
Presented by: Chloe Migneault-Bouchard
In chronic rhinosinusitis (CRS), nasal obstruction can be explained by structural deformities, polyps, or edematous nasal mucosa. In some cases, no major deformity or inflammation is present to explain the sensation of nasal obstruction of these patients. Here, nasal obstruction may result from an alteration of the afferent neural pathways of the trigeminal system responsible for airflow perception. The aim of this study is to assess the involvement of the intranasal trigeminal system in reduced nasal patency in CRS.
Methods: We carried out a prospective case-control study of 15 patients with CRS, 18 patients with a deviated nasal septum (DNS) and 16 healthy controls. We used Peak Nasal Inspiratory Flow (PNIF) and Visual Analog Scale (VAS) to assess objective and subjective nasal patency respectively. We further examined sensitivity of the intranasal trigeminal system using the Trigeminal Lateralization Task (TLT) with eucalyptol and cinnamaldehyde. Finally, we measured expression of trigeminal receptors TRPM8, TRPA1 and TRPV1 in mucosal biopsies taken intraoperatively from CRS patients and DNS patients by quantitative real-time PCR.
Results: CRS patients had significantly lower objective (p=0.046) and subjective (p<0.001) nasal patency than controls. DNS patients scored significantly lower than controls for subjective nasal patency (p<0.001). Regarding the trigeminal sensitivity, CRS patients scored significantly lower than DNS (p=0.047) and controls (p=0.005) with eucalyptol, while no difference was observed for cinnamaldehyde. We did not observe a group difference in the expression of TRPM8, TRPA1 and TRPV1.
Conclusion: The present data suggests that reported nasal obstruction in CRS patients may be linked to a combination of deficient perception of nasal airflow by the trigeminal system and a mechanical obstruction not visible by nasal endoscopy. The association with trigeminal receptors remains to be elucidated.
Funding: Fonds de recherche du Québec – Santé
Methods: We carried out a prospective case-control study of 15 patients with CRS, 18 patients with a deviated nasal septum (DNS) and 16 healthy controls. We used Peak Nasal Inspiratory Flow (PNIF) and Visual Analog Scale (VAS) to assess objective and subjective nasal patency respectively. We further examined sensitivity of the intranasal trigeminal system using the Trigeminal Lateralization Task (TLT) with eucalyptol and cinnamaldehyde. Finally, we measured expression of trigeminal receptors TRPM8, TRPA1 and TRPV1 in mucosal biopsies taken intraoperatively from CRS patients and DNS patients by quantitative real-time PCR.
Results: CRS patients had significantly lower objective (p=0.046) and subjective (p<0.001) nasal patency than controls. DNS patients scored significantly lower than controls for subjective nasal patency (p<0.001). Regarding the trigeminal sensitivity, CRS patients scored significantly lower than DNS (p=0.047) and controls (p=0.005) with eucalyptol, while no difference was observed for cinnamaldehyde. We did not observe a group difference in the expression of TRPM8, TRPA1 and TRPV1.
Conclusion: The present data suggests that reported nasal obstruction in CRS patients may be linked to a combination of deficient perception of nasal airflow by the trigeminal system and a mechanical obstruction not visible by nasal endoscopy. The association with trigeminal receptors remains to be elucidated.
Funding: Fonds de recherche du Québec – Santé