ArticleInternational forum of allergy & rhinology2020
The cotton test redistributes nasal airflow in patients with empty nose syndrome.
Article in International forum of allergy & rhinology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 28 citations in OpenAlex.
- Cluster Analysis of Patients With Empty Nose Syndrome and Its Relation to Surgical Outcome.The Laryngoscope · 2026Article
- Does Total Inferior and Middle Turbinectomy Always Lead to Empty Nose Syndrome?Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026Article
- Nasal Air-Jet Sensitivity Differentiates Empty Nose Syndrome and Turbinate Reduction Patients: A Pilot Study.The Laryngoscope · 2026Article
- Empty nose syndrome: new insights from a CFD approach.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025Article
- Does Total Turbinectomy Always Lead to Empty Nose Syndrome? A Computational Virtual Surgery Study.The Laryngoscope · 2025Article
- Tissue specific stem cell therapy for airway regeneration.Cell proliferation · 2024Article
- Functional, Cosmetic, and Psychological Outcomes after Rhinoplasty.Plastic and reconstructive surgery. Global open · 2024Article
- Surgical and Regenerative Treatment Options for Empty Nose Syndrome: A Systematic Review.Clinical and experimental otorhinolaryngology · 2024Article
- Functional Exercise Capacity and Perceived Exertion in Patients with Empty Nose Syndrome.Diagnostics (Basel, Switzerland) · 2024Article
- Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.Frontiers in surgery · 2024Article
- Inferior meatus augmentation procedure (IMAP) normalizes nasal airflow patterns in empty nose syndrome patients via computational fluid dynamics (CFD) modeling.International forum of allergy & rhinology · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundEmpty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Cotton placement into the inferior meatus often alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by cotton testing.
methodsSix ENS patients (12 sides) with pre-existing sinus computed tomography (CT) imaging were enrolled after marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6-Item Questionnaire [ENS6Q] of >7 points) with office-based cotton testing. The fashioned cotton plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect cotton contouring in the inferior meatus. CT imaging from pre- and post-cotton placement was analyzed using comparative CFD techniques.
resultsAfter cotton placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 ± 4.1 to 3.1 ± 2.4; p < 0.001) were recorded. Using CFD, cotton placement produced an expected 21% increase in upper airway resistance (p < 0.05). However, a significant shift in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (-41%; p < 0.002).
conclusionObjective CFD assessment confirmed that the cotton test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of cotton test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure.
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