Journal Article
. 2013 Apr; 33(1):36-42.

Computational fluid dynamics: a suitable assessment tool for demonstrating the antiobstructive effect of drugs in the therapy of allergic rhinitis

N Achilles 1 N Pasch  A Lintermann  W Schröder  R Mösges  
  • PMID: 23620638
  •     53 References
  •     1 citations


This systematic review aims first to summarize the previous areas of application of computational fluid dynamics (CFD) and then to demonstrate that CFD is also a suitable instrument for generating three-dimensional images that depict drug effects on nasal mucosa. Special emphasis is placed on the three-dimensional visualization of the antiobstructive effect of nasal steroids and antihistamines in the treatment of allergic rhinitis. In the beginning, CFD technology was only used to demonstrate physiological and pathophysiological airflow conditions in the nose and to aid in preoperative planning and postoperative monitoring of surgical outcome in the field of rhinosurgery. The first studies using CFD examined nasal respiratory physiology, important functions of the nose, such as conditioning and warming of inspired air, and the influence of pathophysiological changes on nasal breathing. Also, postoperative outcome of surgical procedures could be "predicted" using the nasal airflow model. Later studies focused on the three-dimensional visualization of the effect of nasal sprays in healthy subjects and postoperative patients. A completely new approach, however, was the use of CFD in the area of allergic rhinitis and the treatment of its cardinal symptom of nasal obstruction. In two clinical trials, a suitable patient with a positive history of allergic rhinitis was enrolled during a symptom-free period after the pollen season. The patient developed typical allergic rhinitis symptoms after provocation with birch pollen. The 3-D visualization showed that the antiallergic treatment successfully counteracted the effects of nasal allergen provocation on nasal airflow. These observations were attributed to the antiobstructive effect of a nasal steroid (mometasone furoate) and a systemic antihistamine (levocetirizine), respectively. CFD therefore constitutes a non-invasive, precise, reliable and objective examination procedure for generating three-dimensional images that depict the effects of drugs used in the treatment of allergic rhinitis.

Keywords: Allergic rhinitis; Antihistamine; Computational fluid dynamics (CFD); Levocetirizine; Mometasone furoate nasal spray (MFNS); Nasal airflow simulation; Nasal obstruction; Nasal steroid.

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Inspirational airflow patterns in deviated noses: a numerical study.
Jian Hua Zhu, Heow Pueh Lee, +3 authors, De Yun Wang.
Comput Methods Biomech Biomed Engin, 2012 Apr 21; 16(12). PMID: 22515677
Effects of septal deviation on the airflow characteristics: using computational fluid dynamics models.
Ting Liu, Demin Han, +5 authors, Shunjiu Cui.
Acta Otolaryngol, 2011 Dec 29; 132(3). PMID: 22201479
Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold.
J D Clarke, M L Hopkins, R Eccles.
Clin Otolaryngol, 2005 Mar 08; 30(1). PMID: 15748187
Septal deviation and nasal resistance: an investigation using virtual surgery and computational fluid dynamics.
Guilherme J M Garcia, John S Rhee, Brent A Senior, Julia S Kimbell.
Am J Rhinol Allergy, 2010 Jan 30; 24(1). PMID: 20109325
Acoustic rhinometry, rhinomanometry and visual analogue scale before and after septal surgery: a prospective 10-year follow-up.
L E Haavisto, J I Sipilä.
Clin Otolaryngol, 2012 Nov 06; 38(1). PMID: 23122056
Drug delivery in the nasal cavity after functional endoscopic sinus surgery: a computational fluid dynamics study.
X B Chen, H P Lee, V F H Chong, D Y Wang.
J Laryngol Otol, 2012 Mar 15; 126(5). PMID: 22414292
Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence.
R F André, H D Vuyk, +2 authors, G J Nolst Trenité.
Clin Otolaryngol, 2010 Jan 15; 34(6). PMID: 20070760
Systematic Review.
A review of the efficacy of desloratadine, fexofenadine, and levocetirizine in the treatment of nasal congestion in patients with allergic rhinitis.
Claus Bachert.
Clin Ther, 2009 Jun 23; 31(5). PMID: 19539095
Allergic rhinitis: treatment based on patient profiles.
Bruce M Prenner, Eric Schenkel.
Am J Med, 2006 Feb 24; 119(3). PMID: 16490466
Numerical simulation of normal nasal cavity airflow in Chinese adult: a computational flow dynamics model.
Jie Tan, Demin Han, +5 authors, Xiangdong Wang.
Eur Arch Otorhinolaryngol, 2011 Sep 23; 269(3). PMID: 21938528
A review of the implications of computational fluid dynamic studies on nasal airflow and physiology.
S C Leong, X B Chen, H P Lee, D Y Wang.
Rhinology, 2010 May 27; 48(2). PMID: 20502749
Potential of levocetirizine in the relief of nasal congestion.
L Klimek.
Int J Clin Pract, 2005 Jun 01; 59(6). PMID: 15924602
4-Phase-Rhinomanometry (4PR)--basics and practice 2010.
Klaus Vogt, Alfredo A Jalowayski, +11 authors, P Zaporoshenko.
Rhinol Suppl, 2010 Jul 24; 21. PMID: 20649107
Pathophysiology of nasal obstruction and meta-analysis of early and late effects of levocetirizine.
J Patou, H De Smedt, P van Cauwenberge, C Bachert.
Clin Exp Allergy, 2006 Aug 17; 36(8). PMID: 16911353
Numerical simulations for detailed airflow dynamics in a human nasal cavity.
Jian Wen, Kiao Inthavong, Jiyuan Tu, Simin Wang.
Respir Physiol Neurobiol, 2008 Apr 02; 161(2). PMID: 18378196
Numerical simulation of humidification and heating during inspiration within an adult nose.
F Sommer, R Kroger, J Lindemann.
Rhinology, 2012 May 23; 50(2). PMID: 22616076
Customized three-dimensional computational fluid dynamics simulation of the upper airway of obstructive sleep apnea.
Sang-Jin Sung, Soo-Jin Jeong, +2 authors, Eung-Kwon Pae.
Angle Orthod, 2006 Oct 13; 76(5). PMID: 17029512
Impact of inferior turbinate hypertrophy on the aerodynamic pattern and physiological functions of the turbulent airflow - a CFD simulation model.
Xiao Bing Chen, Heow Pueh Lee, Vincent Fook Hin Chong, De Yun Wang.
Rhinology, 2010 May 27; 48(2). PMID: 20502754
Subjective nasal fullness and objective congestion.
James N Baraniuk.
Proc Am Thorac Soc, 2011 Mar 03; 8(1). PMID: 21364223    Free PMC article.
Simulation of nasal flow by lattice Boltzmann methods.
M Finck, D Hänel, I Wlokas.
Comput Biol Med, 2006 Sep 12; 37(6). PMID: 16962572
Computational fluid dynamic study on obstructive sleep apnea syndrome treated with maxillomandibular advancement.
Chung-Chih Yu, Hung-Da Hsiao, +4 authors, Yu-Ray Chen.
J Craniofac Surg, 2009 Mar 24; 20(2). PMID: 19305244
An overview of numerical modelling of nasal airflow.
Neil Bailie, Brendan Hanna, John Watterson, Geraldine Gallagher.
Rhinology, 2006 Mar 23; 44(1). PMID: 16550951
Allergic rhinitis and its impact on asthma.
J Bousquet, P Van Cauwenberge, +2 authors, World Health Organization.
J Allergy Clin Immunol, 2001 Nov 15; 108(5 Suppl). PMID: 11707753
Highly Cited. Review.
Evaluation of upper airway obstruction--an ENT perspective.
Sarahn M Wheeler, Jacquelynne P Corey.
Pulm Pharmacol Ther, 2007 Oct 16; 21(3). PMID: 17936659
Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey.
Arthur Shedden.
Treat Respir Med, 2005 Dec 13; 4(6). PMID: 16336028
Assessments of nasal bone fracture effects on nasal airflow: A computational fluid dynamics study.
Xiao Bing Chen, Heow Pueh Lee, Vincent Fook Hin Chong, De Yun Wang.
Am J Rhinol Allergy, 2011 Jun 30; 25(1). PMID: 21711975
Subjective and objective assessments in patients with seasonal allergic rhinitis: effects of therapy with mometasone furoate nasal spray.
E O Meltzer, A A Jalowayski, H A Orgel, A G Harris.
J Allergy Clin Immunol, 1998 Jul 29; 102(1). PMID: 9679846
Numerical study of the aerodynamic effects of septoplasty and partial lateral turbinectomy.
Samet Ozlugedik, Gunes Nakiboglu, +4 authors, Ibrahim Tekdemir.
Laryngoscope, 2007 Nov 22; 118(2). PMID: 18030167
A model of airflow in the nasal cavities: Implications for nasal air conditioning and epistaxis.
Neil Bailie, Brendan Hanna, John Watterson, Geraldine Gallagher.
Am J Rhinol Allergy, 2009 Jun 06; 23(3). PMID: 19490795
Levocetirizine improves quality of life and reduces costs in long-term management of persistent allergic rhinitis.
Claus Bachert, Jean Bousquet, +6 authors, XPERT Study Group.
J Allergy Clin Immunol, 2004 Oct 14; 114(4). PMID: 15480324
Deviated nasal septum hinders intranasal sprays: a computer simulation study.
D O Frank, J S Kimbell, +2 authors, J S Rhee.
Rhinology, 2012 Aug 14; 50(3). PMID: 22888490    Free PMC article.
[Analysis of the character of self-adaptation of nasal structure in patients with nasal septum deviation].
Xiu-Zhen Sun, Yuan-Yuan Tang, +3 authors, Ying-Feng Su.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2008 Aug 23; 43(5). PMID: 18717310
Computational fluid dynamics modeling of the upper airway of children with obstructive sleep apnea syndrome in steady flow.
Chun Xu, SangHun Sin, +4 authors, David M Wootton.
J Biomech, 2005 Aug 16; 39(11). PMID: 16098533
Computed intranasal spray penetration: comparisons before and after nasal surgery.
Dennis O Frank, Julia S Kimbell, Daniel Cannon, John S Rhee.
Int Forum Allergy Rhinol, 2012 Aug 29; 3(1). PMID: 22927179    Free PMC article.
Numerical flow simulation in the post-endoscopic sinus surgery nasal cavity.
Guanxia Xiong, Jiemin Zhan, +3 authors, Geng Xu.
Med Biol Eng Comput, 2008 Aug 30; 46(11). PMID: 18726628
Consensus report on acoustic rhinometry and rhinomanometry.
P A R Clement, F Gordts, Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS.
Rhinology, 2005 Oct 13; 43(3). PMID: 16218509
Rhinosurgical therapy planning via endonasal airflow simulation.
U Bockholt, G Mlynski, W Müller, G Voss.
Comput Aided Surg, 2000 Aug 30; 5(3). PMID: 10964089
Visualization of flow resistance in physiological nasal respiration: analysis of velocity and vorticities using numerical simulation.
Shigeru Ishikawa, Toshio Nakayama, Masahiro Watanabe, Teruo Matsuzawa.
Arch Otolaryngol Head Neck Surg, 2006 Nov 23; 132(11). PMID: 17116815
Numerical simulation of air temperature and airflow patterns in the human nose during expiration.
D Pless, T Keck, +4 authors, J Lindemann.
Clin Otolaryngol Allied Sci, 2004 Nov 10; 29(6). PMID: 15533152
Assessment of septal deviation effects on nasal air flow: a computational fluid dynamics model.
Xiao Bing Chen, Heow Pueh Lee, Vincent Fook Hin Chong, De Yun Wang.
Laryngoscope, 2009 Jul 03; 119(9). PMID: 19572266
Levocetirizine in persistent allergic rhinitis: continuous or on-demand use? A pilot study.
Giorgio Walter Canonica, Federica Fumagalli, +9 authors, Global Allergy and Asthma European Network.
Curr Med Res Opin, 2008 Sep 03; 24(10). PMID: 18761784
Flow mechanisms in the human olfactory groove: numerical simulation of nasal physiological respiration during inspiration, expiration, and sniffing.
Shigeru Ishikawa, Toshio Nakayama, Masahiro Watanabe, Teruo Matsuzawa.
Arch Otolaryngol Head Neck Surg, 2009 Feb 18; 135(2). PMID: 19221243
Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics.
Tomonori Iwasaki, Issei Saitoh, +4 authors, Youichi Yamasaki.
Am J Orthod Dentofacial Orthop, 2012 Mar 03; 141(3). PMID: 22381487
Once-daily mometasone furoate aqueous nasal spray (Nasonex) in seasonal allergic rhinitis: an active- and placebo-controlled study.
J R Hebert, K Nolop, B N Lutsky.
Allergy, 1996 Aug 01; 51(8). PMID: 8874661
Changes of airflow pattern in inferior turbinate hypertrophy: a computational fluid dynamics model.
Heow Pueh Lee, Hee Joo Poh, Fook Hin Chong, De Yun Wang.
Am J Rhinol Allergy, 2009 Apr 30; 23(2). PMID: 19401040
Maxillomandibular advancement surgery for obstructive sleep apnea syndrome.
Jeffrey R Prinsell.
J Am Dent Assoc, 2002 Dec 05; 133(11). PMID: 12462692
[A computational fluid dynamics study of inner flow through nasal cavity with unilateral hypertrophic inferior turbinate].
Yufeng Guo, Yuning Zhang, +5 authors, Xueming Chen.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2009 Dec 25; 23(17). PMID: 20030039
[Allergic rhinoconjunctivitis. Guidelines of the DGAI in association with the DDG].
Claus Bachert, Ulrich Borchard, +6 authors, Johannes Ring.
J Dtsch Dermatol Ges, 2006 Apr 22; 4(3). PMID: 16626325
Aerodynamic effects of inferior turbinate reduction: computational fluid dynamics simulation.
David Wexler, Rebecca Segal, Julia Kimbell.
Arch Otolaryngol Head Neck Surg, 2005 Dec 21; 131(12). PMID: 16365225
Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. 194-079 Study Group.
M Mandl, K Nolop, B N Lutsky.
Ann Allergy Asthma Immunol, 1997 Nov 14; 79(4). PMID: 9357385
Indicators for the correct usage of intranasal medications: A computational fluid dynamics study.
Revanth Reddy Garlapati, Heow Pueh Lee, Fook Hin Chong, De Yun Wang.
Laryngoscope, 2009 Aug 06; 119(10). PMID: 19655385
Effects of septal perforation on nasal airflow: computer simulation study.
H P Lee, R R Garlapati, V F H Chong, D Y Wang.
J Laryngol Otol, 2009 Sep 25; 124(1). PMID: 19775487
Treatment of congestion in upper respiratory diseases.
Eli O Meltzer, Fernan Caballero, +2 authors, Glenis Scadding.
Int J Gen Med, 2010 May 14; 3. PMID: 20463825    Free PMC article.
First Steps to Develop and Validate a CFPD Model in Order to Support the Design of Nose-to-Brain Delivered Biopharmaceuticals.
Lucas Engelhardt, Martina Röhm, +3 authors, Ulrich Simon.
Pharm Res, 2016 Feb 19; 33(6). PMID: 26887679