The impact of nasal airflow on sinus mucosa: A radiographic review

Background: Chronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology. Methods: All patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests. Results: 56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13). Conclusion: In total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.