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Facial Plast Surg 2013; 29(02): 085-092
DOI: 10.1055/s-0033-1341590
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Concept of Rhinorespiratory Homeostasis—A New Approach to Nasal Breathing

Thomas Hildebrandt
1   Private practice of otorhinolaryngology in association with the Limmatklinik, Zurich, Switzerland
,
Werner Johannes Heppt
2   Department of Otorhinolaryngology, Head and Neck Surgery, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
,
Ulrich Kertzscher
3   Biofluid Mechanics Lab, Institute of Laboratory Medicine, Charité, Berlin, Germany
,
Leonid Goubergrits
3   Biofluid Mechanics Lab, Institute of Laboratory Medicine, Charité, Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
05 April 2013 (online)

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Abstract

The suggested concept of rhinorespiratory homeostasis is a new theoretical model for the discussion of physiologic and physical principles of nasal breathing. This model is based on a comprehensive view of nasal functions that takes comparative animal physiology into account. Consequently, it has a universal cross-species character and emphasizes the central role of nasal secretion. In contrast to the established view, the focus is transferred from the inspired air to the nasal wall. This concept considers the parietal effect of airflow represented by wall shear stress with special regard to the epithelial lining fluid. It delivers one possible mechanism of an inherent triggering of the nasal cycle. Furthermore, the issue of biological fluid–structure interaction is introduced. This article presents a rethinking of nasal breathing that was inspired by clinical experience and results of flow field investigations through computational fluid dynamics.

Keywords

nasal airflow - wall shear stress - nasal functions - nasal cycle - rhinorespiratory homeostasis
 

  • References

  • 1 Scott JH. The comparative anatomy and function of the maxillary turbinate. J Anat 1953; 87: 461-462
    PubMedGoogle Scholar
  • 2 Scott JH. Heat regulation function of the nasal mucous membrane. J Laryngol 1954; 68: 56-59
    PubMedGoogle Scholar
  • 3 Rolfes H. Untersuchungen zur Klimatisierungsfunktion der Nase [PhD dissertation]. Berlin, Germany: Freie Universität; 1998
    Google Scholar
  • 4 Cramer II. Heat and moisture exchange of respiratory mucous membrane. Ann Otol Rhinol Laryngol 1957; 66: 327-343
    PubMedGoogle Scholar
  • 5 Negus V. Further observations on the air conditioning mechanism of the nose. Ann R Coll Surg Engl 1960; 27: 171-204
    PubMedGoogle Scholar
  • 6 Hillenius WJ. The Evolution of Nasal Turbinates and Mammalian Endothermy. Paleobiology 1992; 18: 17-29
    PubMedGoogle Scholar
  • 7 Proctor DF. Form and function in the upper airways and larynx. In: Fishman AP, , ed. The Handbook of Physiology. Section 3: The Respiratory System. Volume 3. Mechanics of Breathing, Part 1. Baltimore, MD: The American Physiological Society; 1986: 63-73
    Google Scholar
  • 8 Schmidt-Nielsen K. Physiologie der Tiere. Heidelberg, Germany: Spektrum Akademischer Verlag GmbH; 1999: 234-235 , 289–292
    Google Scholar
  • 9 Schmidt-Nielsen K, Bretz WL, Taylor CR. Panting in dogs: unidirectional air flow over evaporative surfaces. Science 1970; 169: 1102-1104
    CrossrefPubMedGoogle Scholar
  • 10 Blatt CM, Taylor CR, Habal MB. Thermal panting in dogs: the lateral nasal gland, a source of water for evaporative cooling. Science 1972; 177: 804-805
    CrossrefPubMedGoogle Scholar
  • 11 Herberhold C. Comment to Fischer R. Physikalische Modelle zur Nachbildung der physiologischen Funktion der Nase bei der Klimatisierung der Inspirationsluft. Archiv klein exp. Ohren-, Nasen- und Kehlkopfheilk, Bd 202, Heft 2. Kongreßbericht 1972; 1972: 2 Teil
    PubMedGoogle Scholar
  • 12 Koch D, Arnold S, Hubler M, Montavon PM. Brachycephalic syndrome in dogs. 2003 25. 48-55 . Available at: http://www.vetlearn.com
    PubMedGoogle Scholar
  • 13 Oechtering G. Das Brachyzephalensyndrom-Neue Informationen zu einer alten Erbkrankheit. Veterinary Focus 2010; 20: 1-9
    PubMedGoogle Scholar
  • 14 Hochstrasser K. Physiologische Chemie und Pathobiochemie der Nasenschleimhaut. In: Oto-Rhino-Laryngologie in Klinik und Praxis: Nase, Nasennebenhöhlen, Gesicht, Mundhöhle und Pharynx, Kopfspeicheldrüsen Band 2. Stuttgart, Germany: Georg Thieme Verlag; 1992: 60-65
    Google Scholar
  • 15 Drettner B. Physiologie und Pathphysiologie der Nase. In: Oto-Rhino-Laryngologie in Klinik und Praxis: Nase, Nasennebenhöhlen, Gesicht, Mundhöhle und Pharynx, Kopfspeicheldrüsen Band 2. Stuttgart, Germany: Georg Thieme Verlag; 1992: 40-48
    Google Scholar
  • 16 Behrbohm H. Untersuchungen zur Physiologie und zum Reparationsverhalten der Kieferhöhlenschleimhaut [Habilitation]. Berlin, Germany: Humboldt-Universität; 1990
    Google Scholar
  • 17 Behbehani AA. Das Sekret der respiratorischen Schleimhaut: Ein spezieller Flüssigkeitsraum [Habilitation]. München, Germany: Universität München; 1983
    Google Scholar
  • 18 Kersting U, Schwab A, Hebestreit A. Measurement of human nasal potential difference to teach the theory of transepithelial fluid transport. Adv Physiol Educ 1998; 275: 72-77
    PubMedGoogle Scholar
  • 19 Rokahr C. Nasale Potenzialdifferenzmessung in Therapie und Diagnostik der Cystischen Fibrose [PhD dissertation]. Hannover, Germany: Medizinische Hochschule; 2006
    Google Scholar
  • 20 Deetjen S, Hescheler. Transepitheliales Potenzial der Nasenschleimhaut. In: Speckmann E-J, Hescheler J, Köhling R. , eds. Physiologie. München, Germany: Elsevier, Urban & Fischer; 2004: 5-14
    Google Scholar
  • 21 Krahl AJA. Nasale Potentialdifferenzmessung: Zum Einfluß von körperlicher Belastung, Kaltluftexposition und Amiloridpulver [PhD dissertation]. Giessen, Germany: Justus-Liebig- Universität; 2002
    Google Scholar
  • 22 Mairbäurl H, Weymann J, Möhrlein A , et al. Nasal epithelium potential difference at high altitude (4,559 m): evidence for secretion. Am J Respir Crit Care Med 2003; 167: 862-867
    CrossrefPubMedGoogle Scholar
  • 23 Elad D, Naftali S, Rosenfeld M, Wolf M. Physical stresses at the air-wall interface of the human nasal cavity during breathing. J Appl Physiol 2006; 100: 1003-1010
    PubMedGoogle Scholar
  • 24 Even-Tzur N, Kloog Y, Wolf M, Elad D. Mucus secretion and cytoskeletal modifications in cultured nasal epithelial cells exposed to wall shear stresses. Biophys J 2008; 95: 2998-3008
    CrossrefPubMedGoogle Scholar
  • 25 Baumann C. Genexpression von Endothelzellen unter Wandschubspannung [PhD dissertation]. Berlin, Germany: Freie Universität; 2002
    Google Scholar
  • 26 Bongrazio M. Wandschubspannungsregulierte Expression von Proteinen der Thrombospondin type-1 Repeat (TSR) Familie in Endothelzellen [PhD dissertation]. Berlin, Germany: Freie Universität; 2004
    Google Scholar
  • 27 Schmidt VJ. Die Koordination des Gefäßverhaltens in der Mikorzirkulation wird durch Connexine mit spezifischen Eigenschaften vermittelt [PhD dissertation]. Lübeck, Germany: Universität zu Lübeck; 2008
    Google Scholar
  • 28 Schmidt RF, Lang F. Physiologie des Menschen: mit Pathophysiologie. 30. Auflage. Heidelberg, Germany: Springer Medizin Verlag; 2007: 652-654
    CrossrefGoogle Scholar
  • 29 Davies PF. Flow-mediated endothelial mechanotransduction. Physiol Rev 1995; 75: 519-560
    PubMedGoogle Scholar
  • 30 Elad D, Naftali S, Rosenfeld M, Wolf M. Physical stresses at the air-wall interface of the human nasal cavity during breathing. J Appl Physiol 2006; 100: 1003-1010
    PubMedGoogle Scholar
  • 31 Grant O, Bailie N, Watterson J, Cole J, Gallagher G, Hanna B. Numerical model of a nasal septal perforation. Medinfo 2004;
    PubMedGoogle Scholar
  • 32 Doorly DJ, Taylor DJ, Gambaruto AM, Schroter RC, Tolley N. Nasal architecture: form and flow. Philos Transact A Math Phys Eng Sci 2008; 366: 3225-3246
    CrossrefPubMedGoogle Scholar
  • 33 Doorly DJ, Taylor DJ, Schroter RC. Mechanics of airflow in the human nasal airways. Respir Physiol Neurobiol 2008; 163: 100-110
    CrossrefPubMedGoogle Scholar
  • 34 Bailie N, Hanna B, Watterson J, Gallagher G. A model of airflow in the nasal cavities: Implications for nasal air conditioning and epistaxis. Am J Rhinol Allergy 2009; 23: 244-249
    CrossrefPubMedGoogle Scholar
  • 35 Even-Tzur N, Kloog Y, Wolf M, Elad D. Mucus secretion and cytoskeletal modifications in cultured nasal epithelial cells exposed to wall shear stresses. Biophys J 2008; 95: 2998-3008
    CrossrefPubMedGoogle Scholar
  • 36 Chambers LA, Rollins BM, Tarran R. Liquid movement across the surface epithelium of large airways. Respir Physiol Neurobiol 2007; 159: 256-270
    CrossrefPubMedGoogle Scholar
  • 37 Tarran R, Button B, Picher M , et al. Normal and cystic fibrosis airway surface liquid homeostasis. The effects of phasic shear stress and viral infections. J Biol Chem 2005; 280: 35751-35759
    CrossrefPubMedGoogle Scholar
  • 38 Fiedler G. Retrospektive Analyse sinunasaler Erkrankungen bei 104 Patienten nach Laryngektomie [PhD dissertation]. Marburg, Germany: Phillips-Universität; 2008
    Google Scholar
  • 39 Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med 2010; 3: 47-57
    PubMedGoogle Scholar
  • 40 Freund W, Wunderlich AP, Stöcker T, Schmitz BL, Scheithauer MO. Empty nose syndrome: limbic system activation observed by functional magnetic resonance imaging. Laryngoscope 2011; 121: 2019-2025
    PubMedGoogle Scholar
  • 41 Chhabra N, Houser SM. The diagnosis and management of empty nose syndrome. Otolaryngol Clin North Am 2009; 42: 311-330 , ix
    CrossrefPubMedGoogle Scholar
  • 42 Huizing EH, De Groot JAM. Functional Reconstructive Nasal Surgery. 1st ed. Stuttgart, Germany: Georg Thieme Verlag; 2003: 52
    Google Scholar
  • 43 Lung MA, Wang JCC. Autonomic nervous control of nasal vasculature and airflow resistance in the anaesthetized dog. J Physiol 1989; 419: 121-139
    PubMedGoogle Scholar
  • 44 Eccles R. Sympathetic control of nasal erectile tissue. Eur J Respir Dis Suppl 1983; 128 (Pt 1) 150-154
    PubMedGoogle Scholar
  • 45 Mirza N, Kroger H, Doty RL. Influence of age on the “nasal cycle.”. Laryngoscope 1997; 107: 62-66
    CrossrefPubMedGoogle Scholar
  • 46 Eccles R. The central rhythm of the nasal cycle. Acta Otolaryngol 1978; 86: 464-468
    CrossrefPubMedGoogle Scholar
  • 47 Kantchew-Haustein BA. Quantifizierung des menschlichen Nasenzyklus in Beziehung zum Geruchsvermögen [PhD dissertation]. Dresden, Germany: Technische Universität; 2009
    Google Scholar
  • 48 Maurizi M, Paludetti G, Almadori G, Ottaviani F, Todisco T. Mucociliary clearance and mucosal surface characteristics before and after total laryngectomy. Acta Otolaryngol 1986; 102: 136-145
    CrossrefPubMedGoogle Scholar
  • 49 Havas TE, Cole P, Gullane P, Kassel R. Alterations in nasal physiology after laryngectomy: the nasal cycle. J Otolaryngol 1987; 16: 149-153
    PubMedGoogle Scholar
  • 50 Fisher EW, Liu M, Lund VJ. The nasal cycle after deprivation of airflow: a study of laryngectomy patients using acoustic rhinometry. Acta Otolaryngol 1994; 114: 443-446
    CrossrefPubMedGoogle Scholar
  • 51 Hildebrandt T. Das Konzept der Rhinorespiratorischen Homöostase—ein neuer theoretischer Ansatz für die Diskussion physiologischer und physikalischer Zusammenhänge bei der Nasenatmung [PhD dissertation]. Freiburg im Breisgau, Germany: Albert-Ludwigs-Universität; 2011
    Google Scholar