Management Of Nasal Airway Obstruction Research Articles

Diagnostic and Therapeutic Management of Nasal Airway Obstruction: Advances in Diagnosis and Treatment.

Nasal airway obstruction (NAO) is a common complaint in the otolaryngologist's office and can have a negative influence on quality of life (QOL). Existing diagnostic methods have improved, but little consensus exists on optimal tools. Furthermore, although surgical techniques for nasal obstruction continue to be developed, effective outcome measurement is lacking. An update of recent advances in diagnostic and therapeutic management of NAO is warranted. To review advances in diagnosis and treatment of NAO from the last 5 years. PubMed, Embase, CINAHL, the Cochrane Library, LILACS, Web of Science, and Guideline.gov were searched with the terms nasal obstruction and nasal blockage and their permutations from July 26, 2012, through October 23, 2017. Studies were included if they evaluated NAO using a subjective and an objective technique, and in the case of intervention-based studies, the Nasal Obstruction Symptom Evaluation (NOSE) scale and an objective technique. Exclusion criteria consisted of animal studies; patients younger than 14 years; nasal foreign bodies; nasal masses including polyps; choanal atresia; sinus disease; obstructive sleep apnea or sleep-disordered breathing; allergic rhinitis; and studies not specific to nasal obstruction. The initial search resulted in 942 articles. After independent screening by 2 investigators, 46 unique articles remained, including 2 randomized clinical trials, 3 systematic reviews, 3 meta-analyses, and 39 nonrandomized cohort studies (including a combined systematic review and meta-analysis). An aggregate of approximately 32 000 patients were reviewed (including meta-analyses). Of the subjective measures available for NAO, the NOSE scale is outstanding with regard to disease-specific validation and correlation with symptoms. No currently available objective measure can be considered a criterion standard. Structural measures of flow, pressure, and volume appear to be necessary but insufficient to assess NAO. Therefore, novel variables and techniques must continue to be explored in search of an ideal instrument to aid in assessment of surgical outcomes. Nasal airway obstruction is a clinical diagnosis with considerable effects on QOL. An adequate diagnosis begins with a focused history and physical examination and requires a patient QOL measure such as the NOSE scale. Objective measures should be adjunctive and require further validation for widespread adoption. These results are limited by minimal high-quality evidence among studies and the risk of bias in observational studies. NA.

The Effects of Alar Batten Grafts on Nasal Airway Obstruction and Nasal Steroid Use in Patients With Nasal Valve Collapse and Nasal Allergic Symptoms

Clinical management of nasal airway obstruction (NAO) in patients with and without nasal allergic symptoms and nasal valve collapse (NVC). To examine the impact that autologous alar batten grafts have on patients with NAO owing to NVC and their affect on nasal steroid use and allergic symptoms. A prospective study. Indiana University Medical Center, Indianapolis. Patients with NAO due to NVC with or without symptoms of nasal allergic symptoms. All of the patients had placement of autologous batten grafts during the study period. Prospective study of patients with dynamic NVC undergoing alar batten graft treatment. Nasal Obstruction Symptom Evaluation survey preoperatively and postoperatively, prospective outpatient questionnaire to determine use of nasal steroids and presence of nasal allergic symptoms preoperatively and postoperatively. A total of 126 patients underwent surgical intervention for the treatment of NAO due to NVC. All of these patients were using nasal steroid sprays, and 78 patients (62%) also reported nasal allergic symptoms at their initial presentation. At 6-month and 1-year postoperative evaluations, 118 (94%) and 122 (97%), respectively, reported significant improvement of their NAO, regardless if they had presented with or without allergic nasal symptoms. Sixty-two of the 78 patients (79%) who initially presented with NAO owing to NVC and nasal allergic symptoms preoperatively reported significant improvement in their NAO and nasal allergic symptoms postoperatively. Eight of 126 (6%) restarted their use of nasal steroids postoperatively. All 8 of these patients reported nasal allergic symptoms preoperatively. No patients in the nonallergic group continued the use of nasal steroids postoperatively. There was no increase in nasal steroid use at the 12-month follow-up visit. Nasal airway obstruction due to NVC in patients can be surgically treated with autologous alar batten grafts. In addition, the use of alar batten grafts may improve NAO in patients with nasal allergic symptoms and reduces their use of nasal steroids. These results support the idea of potential surgical repair of the nasal valve to treat patients with NAO due to nasal allergic symptoms and NVC. 4.

Augmenting the Nasal Airway: Beyond Septoplasty

Nasal airway obstruction is a common complaint of patients presenting to otolaryngology clinics and can be caused by a variety of anatomic factors. A number of advances in the surgical management of nasal airway obstruction have been made over the last century. The objective of this article is to provide descriptions of the surgical procedures used to augment specific anatomic deviations that lead to obstruction of the nasal airway. The descriptions of surgical procedures were derived from a literature review as well as the empiric knowledge of the senior author. Preoperative considerations of nasal anatomy, the nasal airway, and the L-strut are detailed. Functional rhinoplasty techniques are reviewed including septoplasty, extracorporeal septoplasty, spreader grafts, batten grafts, alar rim grafts, and correction of caudal septal deviation. The symptom, nasal obstruction, may arise from a number of different anatomic and physiological elements. The rhinoplasty surgeon must consider these contributing elements and manage accordingly, to achieve optimal results.

Consequences and management of nasal airway obstruction in the dentofacial deformity patient

At the time of orthognathic surgery the maxillofacial surgeon has an opportunity to further contribute to a patient's quality of life by simultaneously addressing long-standing breathing and sinus drainage difficulties that may coexist with the jaw deformity. Breathing difficulties may range from isolated symptomatic nasal airway obstruction to obstructive sleep apnea syndrome and should not be overlooked. The impact of the combined occurrence of nasal obstruction and maxillary deformity has been recognized and discussed in the literature. Studies have established the correlation of obstructed nasal breathing with the development and predilection for specific patterns of dentofacial deformities. It is imperative that the evaluation of either obstructed nasal breathing or a presenting dentofacial deformity take into account both aspects. Treatment of maxillary dysplasia with specific emphasis of transverse expansion and correction of other intranasal sites of obstruction including deviated septum and hypertrophied inferior turbinates seeks to simultaneously address chronic difficulties with nasal breathing, sinus drainage and the presenting jaw deformity. A long-standing forced mouth breathing pattern with open mouth posture is known to impact on maxillo-mandibular growth and be a major contributing factor to developmental jaw deformities. When indicated, simultaneous management of the maxillary jaw deformity (Le Fort I osteotomy) and intranasal abnormality (septoplasty, reduction of inferior turbinates, recontouring of nasal apertures) is effective for the symptomatic relief of nasal airway obstruction. The complication rate for the intranasal procedures and Le Fort I osteotomy when completed simultaneously are minimal and not higher than expected when each procedure is carried out as an isolated event.

Endoscopic Septoplasty: Revisitation of the Technique, Indications, and Outcomes

Septoplasty is a well-described surgical technique for management of nasal airway obstruction (NAO) and improved access for endoscopic sinus surgery (ESS). The advances in endoscopic techniques have facilitated endoscopic septoplasty (ES). The purpose of this study was to review the surgical technique, indications, and outcomes for ES. A retrospective review was conducted to identify patients undergoing ES between 1998 and 2005 at a tertiary care medical center. Demographic data, operative indications, adjunctive procedures, symptom outcome, and complications were recorded. One hundred sixteen patients with a mean age of 47 years were identified. The male/female ratio was 1.2:1 and mean follow-up period was 13 months. Indications for ES included NAO (64.6%), access (34.5%), and facial pain (0.9%). The most common concomitant diagnoses included chronic rhinosinusitis (67.2%), allergic rhinitis (55.2%), sinonasal polyposis (34.5%), and turbinate hypertrophy (25.9%). Concomitant procedures performed included ESS (81.9%), turbinate reduction (44.8%), and rhinoplasty (4.3%). Among patients who underwent primary ES for NAO, 70% achieved resolution and 20% reported improvement of their nasal obstruction. Complications included transient dental pain/hypesthesia (4.3%), asymptomatic septal perforation (3.4%), synechiae formation (2.6%), epistaxis (0.9%), and septal hematoma (0.9%). Complication rates were similar for ES alone versus ES in conjunction with ESS. ES represents a viable alternative to traditional headlight septoplasty with acceptable outcomes and complications. ES allows for enhanced visualization of the septal deviation with more focused flap dissection and resection of the offending cartilage and bone. Furthermore, the technique facilitates teaching endeavors through use of video monitors.

Endoscopic-Assisted Partial Inferior Turbinate Resection in the Management of Nasal Airway Obstruction

Endoscopic-Assisted Partial Inferior Turbinate Resection in the Management of Nasal Airway Obstruction