Ventilation of the paranasal sinuses and mucociliary clearance from the human nasal mucosa—The effects of functional endoscopic sinus surgery, insertion of a ventilatory tube into the maxillary sinus and YAMIK therapy

Mucosal dysfunction and insufficient ventilation are believed to be the major factors predisposing to sinusitis. Ventilation of the paranasal sinuses is essential for the entry aerosols into their cavities. In this study, we compared the pressures between the human nasal cavity and the maxillary sinus and determined the efficiency of nasal mucociliary clearance by the saccharin test. We simultaneously measured the nasal cavity and maxillary sinus pressures during quiet breathing in a human subject. An enlarged maxillary ostium, creation of an additional counter-opening at the inferior nasal meatus, insertion of a tube and YAMIK therapy markedly increased the differential pressures between the nasal cavity and the maxillary sinus. The differential pressures were increased most significantly with the creation of an additional counter-opening at the inferior meatus, and enlargement of the maxillary ostium. We simultaneously measured the pressures in the two cavities during normal breathing and hyperventilation a human subject. A counter-opening at the inferior meatus was created by operation in 10 of these patients (19 males and 6 females). In the results, the differences in pressures, compared during normal breathing and hyperventilation, were found to be significantly increased during hyperventilation (p<0.01). These results suggest that increased ventilation increased differential pressures between the nasal cavity and the paranasal sinuses due to the increase in the air flow rate in the nasal cavity, and also that when the respiratory frequency is increased the ventilatory exchange between the nasal cavity and the paranasal sinuses is increased. It is suggested that the ventilatory exchange between the nasal cavity and the paranasal sinuses increases as the flow rate of air passing in the nasal cavity increases, and also that when the respiratory frequency is increased even slightly, the ventilatory exchange between the paranasal sinuses and the nasal cavity is markedly increased. From these results, it is considered that the ventilatory exchange between the nasal cavity and the maxillary sinus was significantly increased when a counter-opening was created at the inferior meatus. The nasal mucociliary clearance and the air flow rate in the nasal cavity may increase following enlargement of the maxillary ostium and creation of a counter-opening at the inferior meatus, thereby allowing improved inhalation of aerosol particles into the paranasal sinuses.