Analysis of Post-Endoscopic Endonasal Approach Shows Sinus Pressure When Sneezing May Depend on Anatomy

What is the effect of nasal airway sneezing on sinus pressure in postoperative patients who have received an endoscopic endonasal approach (EEA) to the skull base?

Bottom line: Computational fluid dynamics (CFD) applied in postoperative EEA patients suggest that sinus pressure buildup may depend on individual anatomy.

BACKGROUND: EEA surgeries are used to access and repair skull base defects. To avoid complications such as cerebrospinal fluid leakage or pneumocephalus, EEA patients are given postoperative precautions meant to prevent sinus pressure spikes, such as sneezing only through an open mouth. Evidence behind such precautions has been limited, however.

STUDY DESIGN: Case-control series.

SETTING: Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio.

SYNOPSIS: Researchers enrolled two male and two female post-EEA patients and four randomly selected, gender-matched healthy controls and collected computed tomography or magnetic resonance imaging scans on all eight individuals. CFD techniques were used to create three-dimensional models of each subject’s nasal cavity and simulate airflow and pressure distribution inside the nasal and sinus cavities during sneezing, and to quantify skull base sinus pressures among subjects. In assessing simulated pressure changes, the investigators observed significant increases in skull base peak pressure during sneezing, with significant individual variations. Healthy controls generated significantly higher mean peak pressures than EEA patients during sneezing, possibly because the EEA patients could have had the anterior half of the nasal cavity opened more, leading to lower resistance. Despite these peak pressure variations, pressure values were largely uniform across each measured point along the skull base among the group. Limitations included the small sample size and heterogeneous surgical approaches among the patients.

CITATION: Wu Z, Craig JR, Maza G, et al. Peak sinus pressures during sneezing in healthy controls and post–skull base surgery patients. Laryngoscope. 2020;130:
2138-2143.