- Email: [email protected]
Transnasal cooling: A Pandora’s box of transnasal patho-physiology
Medical Hypotheses 77 (2011) 275–277
Contents lists available at ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Transnasal cooling: A Pandora’s box of transnasal patho-physiology Deepak Gupta ⇑ Department of Anesthesiology, Wayne State University/Detroit Medical Center, School of Medicine, Box No. 162, 3990 John R, Detroit, MI 48201, United States
a r t i c l e
i n f o
Article history: Received 10 March 2011 Accepted 28 April 2011
a b s t r a c t The innovative concept of transnasal evaporative cooling for therapeutic hypothermia in cardiopulmonary-cerebro-resuscitation has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. To affirm the physiological role of transnasal cooling, the innovative non-invasive brain temperature monitoring can help the investigators to explore and understand the following transnasal pathophysiological phenomena: (1) understanding correlation of brain temperature and sinus headache secondary to nasal blockade, (2) exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients, (3) realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants, (4) understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases, (5) exploring the anthropological role of male pattern of moustache, beard and hair loss, and (6) possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings. Ó 2011 Elsevier Ltd. All rights reserved.
The innovation called RhinoChillÒ device (BeneChill Inc., San Diego, California) utilizes the concept of transnasal evaporative cooling for therapeutic hypothermia in cardio-pulmonarycerebro-resuscitation [1–5]. The concept of transnasal cooling demonstrated in animals and humans [6–29] has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. The role of angularis oculi vein in selective brain cooling have been investigated [30,31] and in this regard, the Brain Temperature Tunnel™ [32] discovered by Marc Abreu to continuously monitor brain temperature across the valveless superior ophthalmic vein (the tributary of angularis oculi vein) via a surface probe placed between the right upper eye lid and superior aspect of medial canthus will help in affirming the understanding of these incompletely explored physiological concepts. The keywords ‘‘nasal cooling’’ searched in PUBMED database prompt up 177 published literatures with the first work dated year 1946. This may explain that transnasal cooling phenomenon has been mesmerizing the life scientists for decades. The author recently joined this old bandwagon because based on his personal experiences within the enclosed living environments, the author has been trying to explore this physiological phenomenon and ⇑ Tel.: +1 313 745 7233; fax: +1 313 993 3889. E-mail address: [email protected] 0306-9877/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2011.04.034
have found the champions of this physiological effect who have published medical literature that may partially or completely correlate with the author’s proposed hypotheses. The transnasal cooling may be normal physiological phenomenon that we may have overlooked. This may be the phenomenon [33–42] by which the paranasal sinuses transfers the heat from the highly active deep brain structures to the cooler inspired air and in turn ensures the delivery of warmer inspired air to lungs and prevents the overheating of the deep brain structures. The development of frontal and sphenoidal sinuses with the development of brain further gives support to this explanation that increased brain surface area require increased paranasal sinus area to dissipate the increased heat production [43]. The absence of transnasal cooling effect in the intubated patients may further explain one of the contributing factors for incidence of delirium that may be easily countered by the nasal delivery of high flow oxygen or air till the patient is extubated [44,45]. This phenomenon may explain why claustrophobic patients do not tolerate the oxygen masks but does not complain about the nasal oxygen; this may be easily explained by their higher susceptibility to brain temperature fluctuations as a result of higher temperatures under the tight fitting oxygen masks that do not effectively dissipate the heat energy of the warm expired air between the inspirations [46–48]. The transnasal cooling may explain the phenomenon called White Christmas Blues in people living in snow-covered areas because their inability to go outdoors during winters exposes them to
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D. Gupta / Medical Hypotheses 77 (2011) 275–277
round-the-clock higher temperatures within the confines of heated environments. Additionally, the people’s tendency to keep higher indoor temperatures during the winters as compared to the summers to counter the outdoor temperatures further contributes to this form of depression secondary to ineffective transnasal cooling; paradoxically the target indoor temperatures during winters should be kept lower than the target indoor temperatures during summers as same indoor target temperature achieved by heating the air during winters provides poorer air quality and living comfort levels as compared to the same indoor target temperature achieved by cooling the air during summers. With scientific development, the human race has manipulated their indoor environments that everything has changed by 180° and transnasal cooling provides some of the answers to deal with some of the phenomena poorly understood up till now. For instance, the male pattern of moustache and beard hair distribution may have been meant to protect the deep brain structures from exposure to colder temperatures in the historic times before the advent of air-conditioned environments; the males may have needed this phenomenon compared to the females because higher volumes of brain matter meant the deeper brain structures are far removed from the scalp surface and its covering of insulating scalp hair and hence deeper brain structures in males were more exposed to constant dynamic transnasal cooling that required the additional thermo-insulation with the moustache and beard hair growing on the cancellous/spongy bone structures of upper and lower lip. With time, our species was able to control the living environments and the need for this supplementary thermoinsulation was lost in the temperature controlled enclosed environments. However, it seems we may have overdone in our zeal of controlling the living environments that it seems likely that we may need a coolant moustache made out of miniaturized ice wraps similar to the reusable ice insert used in Ice Bandana by Icy-Cools [49]. This innovative Coolant Moustache can be made available in a pack of a dozen for countering twelve hours of indoor exposure to higher air temperatures with poorer air quality in people known to have poor comfort levels especially during the winters. As compared to painted coolant moustache, the proposed moustache will be environmental friendly because users will be inhaling cooled air instead of evaporative coolant. The transnasal cooling may be able to explain some aspects of the male pattern hair loss that may be a very recent pathological phenomenon coinciding with the human control of their living environments and increasing ratio of human brain versus body activity level, may have higher incidence in the people with moustache, and may respond to local application of coolant emollients on the areas of hair loss. Moreover, the male pattern hair loss may be a misnomer that may become obsolete as the evolving feminism may expose the similar areas of scalp in the females to the underlying brain heat dissipation secondary to the higher cerebral activity in frontal and pre-frontal cortex and associated areas. Transnasal cooling may explain the big protruding noses in the people living in the tropical climate to prevent the hyperthermia from exposure to tropical climates [50,51]. Loss of transnasal cooling in the people exposed to Loo (a strong, hot and dry summer afternoon wind in tropical Indian subcontinent) with high incidence of heat strokes may be analogous to the milder form of discomfort felt by the people living in the enclosed warmer environments during winters. Impaired transnasal cooling may explain the sinus headaches [52] and hypopigmentation of the scalp hair in patients suffering from chronic sinusitis and rhinitis. Similarly transnasal cooling may explain the ambiguous but therapeutic role of nasal oxygen therapy in patients suffering from cluster headaches and in achieving good comfort levels at the end of life in terminally ill patients with irreversible oxygenation deficits [53–58]. Epidemiologically, dynamics of transnasal cooling may
explain the graver morbidity and mortality of the people with pulmonary diseases who are residing in the colder outdoor climates but living in the warmer indoor environments. It is important to realize that when transnasal cooling can rapidly attain protective selective brain hypothermia with maintained core body normothermia to improve the neurological outcomes after cardiac arrest, then it must be playing a subtle but significant physiological role in keeping the human population healthier and less sick in day-today life. To summarize, non-invasive brain temperature monitoring at Brain Temperature Tunnel™ can help the investigators to explore the following transnasal pathophysiological phenomena: (1) Understanding correlation of brain temperature and sinus headache secondary to nasal blockade. (2) Exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients. (3) Realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants. (4) Understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases. (5) Exploring the anthropological role of male pattern of moustache, beard and hair loss. (6) Possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings [59–62]. Conflict of interest None declared. Acknowledgements This author is deeply grateful to the encouragement given by his mentors, Dr. Harold Michael Marsh, Chair and Professor, Department of Anesthesiology, Wayne State University; Dr. William Coplin, Clinical Associate Professor, Department of Neurology, Wayne State University; and Dr. Adam Folbe, Assistant Professor, Department of Otolaryngology, Wayne State University, Detroit, Michigan, United States. References [1] Castrén M, Nordberg P, Svensson L, Taccone F, Vincent JL, Desruelles D, et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation 2010;122:729–36. [2] Busch HJ, Eichwede F, Födisch M, Taccone FS, Wöbker G, Schwab T, et al. Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation 2010;81:943–9. [3] Boller M, Lampe JW, Katz JM, Barbut D, Becker LB. Feasibility of intra-arrest hypothermia induction: a novel nasopharyngeal approach achieves preferential brain cooling. Resuscitation 2010;81:1025–30. [4] Wang H, Barbut D, Tsai MS, Sun S, Weil MH, Tang W. Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest. Resuscitation 2010;81:617–21. [5] Yu T, Barbut D, Ristagno G, Cho JH, Sun S, Li Y, et al. Survival and neurological outcomes after nasopharyngeal cooling or peripheral vein cold saline infusion initiated during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest. Crit Care Med 2010;38:916–21. [6] Blatt CM, Taylor CR, Habal MB. Thermal panting in dogs: the lateral nasal gland, a source of water for evaporative cooling. Science 1972;177:804–5. [7] Baker MA. Influence of the carotid rete on brain temperature in cats exposed to hot environments. J Physiol 1972;220:711–28.
D. Gupta / Medical Hypotheses 77 (2011) 275–277 [8] Krausz S. A pharmacological study of the control of nasal cooling in the dog. Pflugers Arch 1977;372:115–9. [9] Baker MA, Chapman LW. Rapid brain cooling in exercising dogs. Science 1977;195:781–3. [10] Wheeler PE. Elaborate CNS cooling structures in large dinosaurs. Nature 1978;275:441–3. [11] Langman VA, Maloiy GM, Schmidt-Nielsen K, Schroter RC. Nasal heat exchange in the giraffe and other large mammals. Respir Physiol 1979;37:325–33. [12] Goldberg MB, Langman VA, Taylor CR. Panting in dogs: paths of air flow in response to heat and exercise. Respir Physiol 1981;43:327–38. [13] Baker MA. Brain cooling in endotherms in heat and exercise. Annu Rev Physiol 1982;44:85–96. [14] Johnsen HK, Blix AS, Jørgensen L, Mercer JB. Vascular basis for regulation of nasal heat exchange in reindeer. Am J Physiol 1985;249:R617–23. [15] Caputa M, Feistkorn G, Jessen C. Competition for cool nasal blood between trunk and brain in hyperthermic goats. Comp Biochem Physiol A Comp Physiol 1986;85:423–7. [16] Blumberg MS, Moltz H. How the nose cools the brain during copulation in the male rat. Physiol Behav 1988;43:173–6. [17] Elkhawad AO, Al-Zaid NS, Bou-Resli MN. Facial vessels of desert camel (Camelus dromedarius): role in brain cooling. Am J Physiol 1990;258:R602–7. [18] Elkhawad AO. Selective brain cooling in desert animals: the camel (Camelus dromedarius). Comp Biochem Physiol Comp Physiol 1992;101:195–201. [19] Baker MA, Nijland MJ. Selective brain cooling in goats: effects of exercise and dehydration. J Physiol 1993;471:679–92. [20] Einer-Jensen N, Khorooshi MH. Cooling of the brain through oxygen flushing of the nasal cavities in intubated rats: an alternative model for treatment of brain injury. Exp Brain Res 2000;130:244–7. [21] Einer-Jensen N, Khorooshi MH, Petersen MB, Svendsen P. Rapid brain cooling in intubated pigs through nasal flushing with oxygen: prevention of brain hyperthermia. Acta Vet Scand 2001;42:459–64. [22] Jessen C. Selective brain cooling in mammals and birds. Jpn J Physiol 2001;51:291–301. [23] Hagioka S, Takeda Y, Takata K, Morita K. Nasopharyngeal cooling selectively and rapidly decreases brain temperature and attenuates neuronal damage, even if initiated at the onset of cardiopulmonary resuscitation in rats. Crit Care Med 2003;31:2502–8. [24] Harris B, Andrews P. Intranasal selective brain cooling in pigs. Resuscitation 2008;78:102–3. [25] Covaciu L, Allers M, Enblad P, Lunderquist A, Wieloch T, Rubertsson S. Intranasal selective brain cooling in pigs. Resuscitation 2008;76:83–8. [26] Covaciu L, Allers M, Lunderquist A, Rubertsson S. Intranasal cooling with or without intravenous cold fluids during and after cardiac arrest in pigs. Acta Anaesthesiol Scand 2010;54:494–501. [27] Gavhed D, Mäkinen T, Holmér I, Rintamäki H. Face temperature and cardiorespiratory responses to wind in thermoneutral and cool subjects exposed to 10 °C. Eur J Appl Physiol 2000;83:449–56. [28] Gavhed D, Mäkinen T, Holmér I, Rintamäki H. Face cooling by cold wind in walking subjects. Int J Biometeorol 2003;47:148–55. [29] Dohi K, Jimbo H, Abe T, Aruga T. Positive selective brain cooling method: a novel, simple, and selective nasopharyngeal brain cooling method. Acta Neurochir 2006;96(Suppl.):409–12. [30] Maloney SK, Mitchell G. Selective brain cooling: role of angularis oculi vein and nasal thermoreception. Am J Physiol 1997;273:R1108–16. [31] Fuller A, Hetem RS, Meyer LC, Maloney SK. Angularis oculi vein blood flow modulates the magnitude but not the control of selective brain cooling in sheep. Am J Physiol Regul Integr Comp Physiol 2011. [32] http://www.braintunnelgenix.com last accessed on March 10, 2011. [33] Yamagiwa M, Hilberg O, Pedersen OF, Lundqvist GR. Evaluation of the effect of localized skin cooling on nasal airway volume by acoustic rhinometry. Am Rev Respir Dis 1990;141:1050–4. [34] Lundqvist GR, Pedersen OF, Hilberg O, Nielsen B. Nasal reaction to changes in whole body temperature. Acta Otolaryngol 1993;113:783–8. [35] White MD, Cabanac M. Nasal mucosal vasodilatation in response to passive hyperthermia in humans. Eur J Appl Physiol Occup Physiol 1995;70:207–12. [36] White MD, Cabanac M. Physical dilatation of the nostrils lowers the thermal strain of exercising humans. Eur J Appl Physiol Occup Physiol 1995;70:200–6. [37] Kuhnen G. Unilateral selective brain cooling. Pflugers Arch 1995;430:1018–20.
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[38] Zenker W, Kubik S. Brain cooling in humans–anatomical considerations. Anat Embryol (Berl) 1996;193:1–13. [39] Nagasaka T, Brinnel H, Hales JR, Ogawa T. Selective brain cooling in hyperthermia: the mechanisms and medical implications. Med Hypotheses 1998;50:203–11. [40] Lindemann J, Tsakiropoulou E, Scheithauer MO, Konstantinidis I, Wiesmiller KM. Impact of menthol inhalation on nasal mucosal temperature and nasal patency. Am J Rhinol 2008;22:402–5. [41] Chu YH, Wu CC, Wu CH, Wang HW. Low temperature results in decreased tension in decellularized human nasal mucosa. Am J Rhinol Allergy 2009;23:162–6. [42] Lindemann J, Wiesmiller K, Keck T, Kastl K. Dynamic nasal infrared thermography in patients with nasal septal perforations. Am J Rhinol Allergy 2009;23:471–4. [43] Pless D, Keck T, Wiesmiller K, Rettinger G, Aschoff AJ, Fleiter TR, et al. Numerical simulation of air temperature and airflow patterns in the human nose during expiration. Clin Otolaryngol Allied Sci 2004;29:642–7. [44] Einer-Jensen N, Baptiste KE, Madsen F, Khorooshi MH. Can intubation harm the brain in critical care situations? A new simple technique may provide a method for controlling brain temperature. Med Hypotheses 2002;58:229–31. [45] Harris BA, Andrews PJ, Murray GD. Enhanced upper respiratory tract airflow and head fanning reduce brain temperature in brain-injured, mechanically ventilated patients: a randomized, crossover, factorial trial. Br J Anaesth 2007;98:93–9. [46] Griffin MP, McFadden Jr ER, Ingram Jr RH. Airway cooling in asthmatic and nonasthmatic subjects during nasal and oral breathing. J Allergy Clin Immunol 1982;69:354–9. [47] Morton AR, King K, Papalia S, Goodman C, Turley KR, Wilmore JH. Comparison of maximal oxygen consumption with oral and nasal breathing. Aust J Sci Med Sport 1995;27:51–5. [48] Hayashi C, Tokura H. The effects of two kinds of mask (with or without exhaust valve) on clothing microclimates inside the mask in participants wearing protective clothing for spraying pesticides. Int Arch Occup Environ Health 2004;77:73–8. [49] http://www.icewraps.net/icy-cool-ice-bandana-blue.html last accessed on March 10, 2011. [50] Franciscus RG, Trinkaus E. Nasal morphology and the emergence of Homo erectus. Am J Phys Anthropol 1988;75:517–27. [51] Irmak MK, Korkmaz A, Erogul O. Selective brain cooling seems to be a mechanism leading to human craniofacial diversity observed in different geographical regions. Med Hypotheses 2004;63:974–9. [52] Willatt DJ, Jones AS. The role of the temperature of the nasal lining in the sensation of nasal patency. Clin Otolaryngol Allied Sci 1996;21:519–23. [53] LeBlanc J, Blais B, Barabé B, Côté J. Effects of temperature and wind on facial temperature, heart rate, and sensation. J Appl Physiol 1976;40:127–31. [54] Steegmann Jr AT. Human facial temperatures in natural and laboratory cold. Aviat Space Environ Med 1979;50:227–32. [55] Kratzing CC, Cross RB. Effects of facial cooling during exercise at high temperature. Eur J Appl Physiol Occup Physiol 1984;53:118–20. [56] Koskela H, Tukiainen H. Facial cooling, but not nasal breathing of cold air, induces bronchoconstriction: a study in asthmatic and healthy subjects. Eur Respir J 1995;8:2088–93. [57] Heindl S, Struck J, Wellhöner P, Sayk F, Dodt C. Effect of facial cooling and cold air inhalation on sympathetic nerve activity in men. Respir Physiol Neurobiol 2004;142:69–80. [58] Galbraith S, Fagan P, Perkins P, Lynch A, Booth S. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage 2010;39:831–8. [59] Michael GA, Rolhion P. Cool colors: color-induced nasal thermal sensations. Neurosci Lett 2008;436:141–4. [60] Schmid A, Pyrski M, Biel M, Leinders-Zufall T, Zufall F. Grueneberg ganglion neurons are finely tuned cold sensors. J Neurosci 2010;30:7563–8. [61] Michael GA, Relland S, Borg C, Peyron R, Thomas-Anterion C. A role for the insula in color-induced nasal thermal sensations. Behav Brain Res 2010;212:103–8. [62] Michael GA, Galich H, Relland S, Prud’hon S. Hot colors: the nature and specificity of color-induced nasal thermal sensations. Behav Brain Res 2010;207:418–28.
Contents lists available at ScienceDirect
Medical Hypotheses journal homepage: www.elsevier.com/locate/mehy
Transnasal cooling: A Pandora’s box of transnasal patho-physiology Deepak Gupta ⇑ Department of Anesthesiology, Wayne State University/Detroit Medical Center, School of Medicine, Box No. 162, 3990 John R, Detroit, MI 48201, United States
a r t i c l e
i n f o
Article history: Received 10 March 2011 Accepted 28 April 2011
a b s t r a c t The innovative concept of transnasal evaporative cooling for therapeutic hypothermia in cardiopulmonary-cerebro-resuscitation has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. To affirm the physiological role of transnasal cooling, the innovative non-invasive brain temperature monitoring can help the investigators to explore and understand the following transnasal pathophysiological phenomena: (1) understanding correlation of brain temperature and sinus headache secondary to nasal blockade, (2) exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients, (3) realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants, (4) understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases, (5) exploring the anthropological role of male pattern of moustache, beard and hair loss, and (6) possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings. Ó 2011 Elsevier Ltd. All rights reserved.
The innovation called RhinoChillÒ device (BeneChill Inc., San Diego, California) utilizes the concept of transnasal evaporative cooling for therapeutic hypothermia in cardio-pulmonarycerebro-resuscitation [1–5]. The concept of transnasal cooling demonstrated in animals and humans [6–29] has therapeutic implications with evidence of rapid and selective brain cooling; however, this author wants to elicit that this concept may hold answers for many physiological phenomena which have not been explored or completely understood up till now. The role of angularis oculi vein in selective brain cooling have been investigated [30,31] and in this regard, the Brain Temperature Tunnel™ [32] discovered by Marc Abreu to continuously monitor brain temperature across the valveless superior ophthalmic vein (the tributary of angularis oculi vein) via a surface probe placed between the right upper eye lid and superior aspect of medial canthus will help in affirming the understanding of these incompletely explored physiological concepts. The keywords ‘‘nasal cooling’’ searched in PUBMED database prompt up 177 published literatures with the first work dated year 1946. This may explain that transnasal cooling phenomenon has been mesmerizing the life scientists for decades. The author recently joined this old bandwagon because based on his personal experiences within the enclosed living environments, the author has been trying to explore this physiological phenomenon and ⇑ Tel.: +1 313 745 7233; fax: +1 313 993 3889. E-mail address: [email protected] 0306-9877/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2011.04.034
have found the champions of this physiological effect who have published medical literature that may partially or completely correlate with the author’s proposed hypotheses. The transnasal cooling may be normal physiological phenomenon that we may have overlooked. This may be the phenomenon [33–42] by which the paranasal sinuses transfers the heat from the highly active deep brain structures to the cooler inspired air and in turn ensures the delivery of warmer inspired air to lungs and prevents the overheating of the deep brain structures. The development of frontal and sphenoidal sinuses with the development of brain further gives support to this explanation that increased brain surface area require increased paranasal sinus area to dissipate the increased heat production [43]. The absence of transnasal cooling effect in the intubated patients may further explain one of the contributing factors for incidence of delirium that may be easily countered by the nasal delivery of high flow oxygen or air till the patient is extubated [44,45]. This phenomenon may explain why claustrophobic patients do not tolerate the oxygen masks but does not complain about the nasal oxygen; this may be easily explained by their higher susceptibility to brain temperature fluctuations as a result of higher temperatures under the tight fitting oxygen masks that do not effectively dissipate the heat energy of the warm expired air between the inspirations [46–48]. The transnasal cooling may explain the phenomenon called White Christmas Blues in people living in snow-covered areas because their inability to go outdoors during winters exposes them to
276
D. Gupta / Medical Hypotheses 77 (2011) 275–277
round-the-clock higher temperatures within the confines of heated environments. Additionally, the people’s tendency to keep higher indoor temperatures during the winters as compared to the summers to counter the outdoor temperatures further contributes to this form of depression secondary to ineffective transnasal cooling; paradoxically the target indoor temperatures during winters should be kept lower than the target indoor temperatures during summers as same indoor target temperature achieved by heating the air during winters provides poorer air quality and living comfort levels as compared to the same indoor target temperature achieved by cooling the air during summers. With scientific development, the human race has manipulated their indoor environments that everything has changed by 180° and transnasal cooling provides some of the answers to deal with some of the phenomena poorly understood up till now. For instance, the male pattern of moustache and beard hair distribution may have been meant to protect the deep brain structures from exposure to colder temperatures in the historic times before the advent of air-conditioned environments; the males may have needed this phenomenon compared to the females because higher volumes of brain matter meant the deeper brain structures are far removed from the scalp surface and its covering of insulating scalp hair and hence deeper brain structures in males were more exposed to constant dynamic transnasal cooling that required the additional thermo-insulation with the moustache and beard hair growing on the cancellous/spongy bone structures of upper and lower lip. With time, our species was able to control the living environments and the need for this supplementary thermoinsulation was lost in the temperature controlled enclosed environments. However, it seems we may have overdone in our zeal of controlling the living environments that it seems likely that we may need a coolant moustache made out of miniaturized ice wraps similar to the reusable ice insert used in Ice Bandana by Icy-Cools [49]. This innovative Coolant Moustache can be made available in a pack of a dozen for countering twelve hours of indoor exposure to higher air temperatures with poorer air quality in people known to have poor comfort levels especially during the winters. As compared to painted coolant moustache, the proposed moustache will be environmental friendly because users will be inhaling cooled air instead of evaporative coolant. The transnasal cooling may be able to explain some aspects of the male pattern hair loss that may be a very recent pathological phenomenon coinciding with the human control of their living environments and increasing ratio of human brain versus body activity level, may have higher incidence in the people with moustache, and may respond to local application of coolant emollients on the areas of hair loss. Moreover, the male pattern hair loss may be a misnomer that may become obsolete as the evolving feminism may expose the similar areas of scalp in the females to the underlying brain heat dissipation secondary to the higher cerebral activity in frontal and pre-frontal cortex and associated areas. Transnasal cooling may explain the big protruding noses in the people living in the tropical climate to prevent the hyperthermia from exposure to tropical climates [50,51]. Loss of transnasal cooling in the people exposed to Loo (a strong, hot and dry summer afternoon wind in tropical Indian subcontinent) with high incidence of heat strokes may be analogous to the milder form of discomfort felt by the people living in the enclosed warmer environments during winters. Impaired transnasal cooling may explain the sinus headaches [52] and hypopigmentation of the scalp hair in patients suffering from chronic sinusitis and rhinitis. Similarly transnasal cooling may explain the ambiguous but therapeutic role of nasal oxygen therapy in patients suffering from cluster headaches and in achieving good comfort levels at the end of life in terminally ill patients with irreversible oxygenation deficits [53–58]. Epidemiologically, dynamics of transnasal cooling may
explain the graver morbidity and mortality of the people with pulmonary diseases who are residing in the colder outdoor climates but living in the warmer indoor environments. It is important to realize that when transnasal cooling can rapidly attain protective selective brain hypothermia with maintained core body normothermia to improve the neurological outcomes after cardiac arrest, then it must be playing a subtle but significant physiological role in keeping the human population healthier and less sick in day-today life. To summarize, non-invasive brain temperature monitoring at Brain Temperature Tunnel™ can help the investigators to explore the following transnasal pathophysiological phenomena: (1) Understanding correlation of brain temperature and sinus headache secondary to nasal blockade. (2) Exploring the therapeutic role of nasal oxygen for prevention of delirium in intubated patients. (3) Realizing the impact of controlled enclosed environments on the mood and affect of the inhabitants. (4) Understanding the etio-pathogenesis of claustrophobia after excluding the confounding factors of morbid obesity, severe cardiopulmonary disease and incapacitating musculoskeletal diseases. (5) Exploring the anthropological role of male pattern of moustache, beard and hair loss. (6) Possible development of a coolant moustache as proposed by the author. In summary, transnasal pathophysiology offers many promising lines of fruitful research to explore the non-olfactory physiological functions of nose in human beings [59–62]. Conflict of interest None declared. Acknowledgements This author is deeply grateful to the encouragement given by his mentors, Dr. Harold Michael Marsh, Chair and Professor, Department of Anesthesiology, Wayne State University; Dr. William Coplin, Clinical Associate Professor, Department of Neurology, Wayne State University; and Dr. Adam Folbe, Assistant Professor, Department of Otolaryngology, Wayne State University, Detroit, Michigan, United States. References [1] Castrén M, Nordberg P, Svensson L, Taccone F, Vincent JL, Desruelles D, et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation 2010;122:729–36. [2] Busch HJ, Eichwede F, Födisch M, Taccone FS, Wöbker G, Schwab T, et al. Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation 2010;81:943–9. [3] Boller M, Lampe JW, Katz JM, Barbut D, Becker LB. Feasibility of intra-arrest hypothermia induction: a novel nasopharyngeal approach achieves preferential brain cooling. Resuscitation 2010;81:1025–30. [4] Wang H, Barbut D, Tsai MS, Sun S, Weil MH, Tang W. Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest. Resuscitation 2010;81:617–21. [5] Yu T, Barbut D, Ristagno G, Cho JH, Sun S, Li Y, et al. Survival and neurological outcomes after nasopharyngeal cooling or peripheral vein cold saline infusion initiated during cardiopulmonary resuscitation in a porcine model of prolonged cardiac arrest. Crit Care Med 2010;38:916–21. [6] Blatt CM, Taylor CR, Habal MB. Thermal panting in dogs: the lateral nasal gland, a source of water for evaporative cooling. Science 1972;177:804–5. [7] Baker MA. Influence of the carotid rete on brain temperature in cats exposed to hot environments. J Physiol 1972;220:711–28.
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