The aerodynamics of the sinonasal interface: the nose takes wing-a paradigm shift for our time.

BACKGROUND: Ventilation of and gas exchange between the nose and the paranasal sinuses are believed to occur by convection and diffusion based on experiments that neglect the effects of physiological respiration and aerodynamic forces at the sinonasal interface (SNI). Based on these experiments, the exchange of gas is presumed to be slow, and principally dependent on gas concentration and diameter, number, and location of ostia.

METHODS: In 12 healthy adult volunteers, real-time sinus nitric oxide measurements were obtained with catheters placed through natural ostia during respiratory maneuvers.

RESULTS: The nose is a masterful collection of aerodynamic foils and channels designed to accomplish powered sinonasal gas exchange and ventilation within a few seconds during each inspiration.

CONCLUSION: The new perspective on the functional anatomy of the SNI demands a paradigm shift that is followed by physiological, medical, and surgical implications and a radical change in our perception and understanding.