Profiling nasal trigeminal sensitivity to predict outcomes after nasal obstruction surgery

Predicting symptom improvement after nasal airway obstruction surgery remains difficult, as objective airflow metrics correlate poorly with patient-reported outcomes. Since trigeminal afferents are key in sensing nasal airflow, this study evaluated whether individual differences in nasal chemosensory functionâ€"particularly trigeminal sensitivityâ€"are associated with subjective airflow perception and predict outcomes in patients undergoing surgery for nasal obstruction.

A prospective cohort study was conducted in 43 participants (32 patients with nasal airway obstruction scheduled for surgery, 11 healthy controls). Trigeminal sensitivity was assessed using measures including the menthol lateralisation detection thresholds, TRPV1/TRPM8 gene expression, and the trigeminal subtest of the Barcelona Smell Test-24. Olfactory and gustatory function were also evaluated. Nasal obstruction perception was measured pre- and postoperatively using the NOSE-e questionnaire and a visual analogue scale. Patients were followed for a mean of 10.9 months.

Trigeminal sensitivity did not differ significantly between patients and controls. However, baseline trigeminal Barcelona Smell Test-24 scores correlated with greater improvement in NOSE-e scores and satisfaction. Patients with NOSE-e improvement >6 points had lower baseline trigeminal scores than those with lesser gains. No other baseline chemosensory measures were correlated with postoperative outcomes.

Trigeminal sensitivityâ€"particularly as assessed by the Barcelona Smell Test-24 testâ€"may serve as a predictor of both symptom improvement and overall satisfaction after surgery for nasal airway obstruction, underscoring the importance of sensory processing in shaping patient-perceived surgical outcomes.