Nasal Function Research Articles

The acute effects of the PAP treatment on nasal mucosa in patients with OSAS

Abstract BACKGROUND. Obstructive sleep apnea syndrome (OSAS) is a common disease in developed countries. PAP (Positive Airway Pressure) therapy is the most commonly used treatment modality, particularly in moderate to severe OSAS patients. However, several side effects make PAP treatment challenging to tolerate. This study examined the acute effects of PAP treatment on nasal functions. MATERIAL AND METHODS. This study included 32 patients who were diagnosed with severe OSAS following a PSG test and started PAP treatment. Symptom analysis was carried out with the SNOT-20 questionnaire; nasal physiological analysis was carried out with rhinomanometry and acoustic rhinometry tests performed before and after PAP treatment for one night and for one month. A saccharin test was carried out to assess the nasal mucociliary clearance before and after the treatment. RESULTS. A statistically significant difference between nasal symptom scores (p=0.003) and sleep quality (p=0.006) was observed in SNOT-20 questionnaire results. Total nasal resistance was significantly increased after one night’s sleep with PAP and after a one-month treatment with PAP. It was found that there was a statistically significant relation between the total nasal resistance value and PAP pressure. CONCLUSION. This study shows that PAP treatment increases nasal congestion after one night of treatment and after one month of treatment with a cumulative effect. PAP therapy positively affects sleeping quality and life quality, while negatively affecting nasal functions in the acute period.

Efficacy of Clarithromycin Combined with Fluticasone Propionate on Nasal Function, Nasal Mucociliary Transport Function, and Serum Inflammatory Markers in Chronic Rhinosinusitis Patients After Functional Endoscopic Sinus Surgery.

Objective: This study aims to assess the efficacy of clarithromycin (CAM) combined with fluticasone propionate (FP) in patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS), focusing on nasal function, nasal mucociliary transport (MCT) function, and serum inflammatory markers. Methods: The control group (n = 48) was treated with FESS alone, while the study group (n = 48) was treated with FESS plus CAM combined with FP. The clinical effects, symptom scores, nasal function, nasal MCT function, serum inflammatory marker levels, and the occurrence of adverse reactions were compared. Results: The total efficacy rate of the study group (95.83%) was significantly higher than that of the control group (83.33%). After treatment, the study group showed lower symptom scores for nasal congestion, runny nose, sneezing and dizziness, and headache compared to those in the control group. The study group also had lower nasal airway resistance, shorter distance from the minimal cross-sectional area to the nostril, and lower T&T olfactory scores. In contrast, their nasal cavity volume and minimal cross-sectional area were higher than those of the control group. Additionally, the nasal mucociliary clearance and MCT rates were higher in the study group. Serum levels of interleukin-6, interleukin-8, tumor necrosis factor-α, and procalcitonin were significantly lower in the study group compared to the control group (all P < .05). Conclusion: The use of CAM combined with FP in patients after FESS for CRS is effective, leading to the relief of clinical symptoms, improvement of nasal function, enhancement of MCT function, and reduction of inflammatory response, without increasing the incidence of adverse reactions.

Clinical effects of two kinds of nasal bone reductors used for shortened and displaced overlapping external nasal fracture reduction under nasal endoscopy and the impact on ventilation function

Objective:To explore the clinical effects of two kinds of nasal bone reductors used for shortened and displaced overlapping external nasal fracture reduction under nasal endoscopy and the impact on ventilation function. Methods:From January 2020 to February 2022, 82 patients with shortened and displaced overlapping external nasal fractures diagnosed and treated in the Department of Otolaryngology, the Second People's Hospital of Hefei were collected as the study subjects. The patients were divided into control group（41 cases） and observation group（41 cases） by random number table method. Both groups underwent closed reduction under nasal endoscopy. The control group was treated with traditional straight nasal bone reductor, and the observation group was treated with gun-shaped hook type nasal bone reductor. The success rate of reduction, follow-up rate, clinical effect, and complications were compared between the two groups. The visual analogue scale（VAS） was used to evaluate the aesthetic effect and functional recovery. Rhinomanometry and acoustic rhinometry were used to evaluate nasal ventilation function. Results:The success rate of one-time reduction in the observation group was significantly higher than that in the control group, and the nasal reduction adaptation time was shorter than that in the control group（P<0.05）. There was no significant difference in the follow-up rate of 95.12% and 92.68% between the two groups. The success rate of one-time reduction in observation group was significantly higher than that in the control group, and the adaptation time for nasal reduction in observation group was shorter than that in the control group（P<0.05）. There was no significant difference in the follow-up rate of 95.12% and 92.68% between the two groups in six months after surgery. the total clinical effective rate in observation group was higher than that in the control group（94.87% vs 76.32%, P<0.05）. After surgery, the scores of nasal aesthetics, nasal congestion and olfactory function in both groups were significantly lower compared with the preoperative scores. All the scores in the observed group were lower than that in the control group（P<0.05）. After surgery, there were significant increases in the minimum cross-sectional area of nasal cavity, volume of nasal cavity and total nasal expiratory volume in both groups. Above indicators in observation group were significantly greater than that in control group. The nasal exhalation and inhalation resistance was significantly lower than that before operation, and the resistance in observation group was significantly lower than that in control group（P<0.05）. The total incidence of complications was lower than that in observation group（P<0.05）. Conclusion:The application of gun-shaped hook-type nasal bone reductor in patients with shortened and displaced overlapping external nasal fractures has better success rate of one-time reduction, adaptation time of nasal reduction and treatment outcome. Moreover, it has more advantages in aesthetic effect of nasal appearance, nasal ventilation function and reduction of complications.

Mesenchymal stem cell-derived small extracellular vesicles restored nasal barrier function in allergic rhinitis via miR-143–GSK3β in human nasal epithelial cells

BackgroundThe nasal epithelial barrier is the first line of defense against the deep entry of pathogens or aeroallergens, and is more critical in allergic rhinitis (AR). Restoring epithelial barrier dysfunction might be a promising strategy for AR. Recent studies reported that mesenchymal stem cell (MSC)-derived small extracellular vesicles (MSC-sEV) potentially inhibit the inflammation response and promote tissue regeneration. However, their effect on nasal epithelial cells remains unknown. ObjectivesThis study sought to describe the therapeutic effect of MSC-sEV on AR, particularly focusing their effect on nasal epithelial cells and underlying molecular mechanisms. MethodsWe utilized an ovalbumin (OVA)-induced mouse model to study AR. Both primary and immortalized human nasal epithelial cells were used to further validate the therapeutic effects of MSC-sEV on epithelial cell function. Then we constructed miR-143 overexpressing and low-expressing HNEpC and MSC-sEV to elucidate molecular mechanisms. Transcriptome analysis was performed to identify the downstream pathways involved. ResultsMSC-sEV successfully maintained nasal barrier integrity in AR mouse model. The MSC-sEV therapeutic effect on the nasal barrier was substantiated in HNEpC. Mechanistically, microRNA (miR)-143 was a candidate mediator of the above effects. Subsequently, transfecting HNEpC with miR-143 partially mimicked the restoring effect of MSC-sEV. MSC-sEV overexpressing miR-143 exerted more therapeutic effects on tight junctions and barrier integrity. Moreover, miR-143 regulated the GSK3β pathway. ConclusionsOur results indicated that MSC-sEV mitigated AR and restored nasal epithelial barrier dysfunction through the miR-143–GSK3β axis, which suggested that MSC-sEV have the remarkable ability to treat AR.

Evaluation of nasal mucociliary clearance in patients with psoriasis.

Psoriasis is an autoimmune pathology characterized by chronic inflammation with known multiorgan involvement. In the literature, there are few studies investigating the effects of psoriasis on upper respiratory tract mucosa. Our aim in our study was to investigate the possible effect of psoriasis disease severity and duration on nasal mucosa. A study group was formed from patients with psoriasis and disease duration, Psoriasis Area Severity Index (PASI) and Nasal Obstruction Symptom Evaluation (NOSE) scores of these patients were recorded. Demographic data were noted in all participants with the participation of control group patients, saccharin test was performed to evaluate the nasal mucosa and nasal mucociliary clearance (NMC) times were measured. Psoriasis patients with pathology that may cause nasal obstruction were excluded from the study. A total of 59 people (30 patients and 29 controls) aged 20-65 years were included in the study. There was no difference in age and gender distribution between the two groups. No statistically significant difference in the NMC time between two groups. In the patients group, a correlation was observed between the NMC time to the NOSE test, but no correlation was observed between the NMC time to the duration of the disease and the PASI score. In our study, no difference was observed in NMC time between the two groups and according to the duration or severity of the disease. In addition, NOSE score of patients was also relatively low. No significant impact of psoriasis on nasal functions was found.

Cost-utility and clinical outcome analysis of surgery or oral corticosteroids treatment in patients with chronic rhinosinusitis with nasal polyps

Background: Surgery and oral corticosteroids are recommended therapies for chronic rhinosinusitis with nasal polyps (CRSwNP) patients who are nonresponsive to intranasal corticosteroid treatment. Objective: This study aimed to compare the effectiveness of these 2 treatments in terms of improving sinus-related symptoms, enhancing quality of life, and economic costs and duration costs. Methods: This prospective study enrolled CRSwNP patients. All participants were instructed to complete the 22-item Sino-Nasal Outcome Test (SNOT-22), visual analog scale, and 36-item short-form (SF-36) questionnaire at baseline and 3 months after treatment. The nasal polyp score (NPS) was assessed via endoscopic examination. Additionally, patients were requested to maintain records of economic direct costs, other indirect costs, and duration costs throughout the 3-month period and to report them during each follow-up visit. Results: A total of 40 patients who underwent surgery or received oral corticosteroids were enrolled in this study. After 3 months of treatment, significant improvements were observed between baseline and 3 months after treatment in the NPS, total SNOT-22 score, and nasal congestion, runny nose, facial pain, olfactory function, and overall symptoms measured. Only headache and sleep order were improved in the surgery group. Both physical functioning and general health, as measured by the SF-36, improved after both treatments, and the role-physical, bodily pain, and social functioning domains of the SF-36 improved only in the surgery group. The changes in the NPS, nasal congestion, runny nose, olfactory function, and sleep disorders in the surgery group were greater than those in the oral corticosteroid group (P values = 0.0003, 0.0092, 0.0258, 0.0284, and 0.0164, respectively). Changes in the total SNOT-22 score and SF-36 subscores were not different between the 2 treatment groups. The direct economic costs and duration costs of surgical treatment were 4.5 times and 17.0 times higher, respectively, than those of oral corticosteroid treatment. Conclusions: Both surgical and oral corticosteroid treatments effectively improved clinical symptoms and quality of life in patients with CRSwNP. Patients who underwent surgery exhibited greater improvements in sinus-related symptoms. Nevertheless, oral corticosteroid treatment presented notable advantages in terms of economic cost and duration cost of disease-related care.

Long-Term Quality of Life Among Patients Undergoing Endoscopic Pituitary Gland Surgery.

Introduction/Objectives: The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL remain limited. To evaluate patients' long-term nasal- and tumor-related QOL after endoscopic endonasal resection of pituitary tumors and to detect predictors for poor postoperative QOL. Study Design: This study was a prospective cohort study. Methods: All patients with pituitary adenomas who underwent trans-sphenoidal surgery at Tel Aviv Sourasky Medical Center between 2014 and 2021 were recruited. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery and 1, 2, and 3-5 years after surgery. Clinical data were collected and analyzed. Results: The study included 43 patients (18 women). No significant decrease was observed in tumor-related quality of life (QOL) scores, measured by ASBS-Q and SNOT-22, throughout the 5-year follow-up period. SNOT-22 score differences from the preoperative baseline at years 1, 3, and 5 were 0.81 [-4.84-6.58], 3.35 [-4.32-11.02], and 3.73 [-2.22-9.68], respectively, with no statistically significant changes. ASBS-Q scores similarly showed no significant changes over time. Subgroup analyses revealed that tumor characteristics (secreting vs. non-secreting, size), surgical factors (intraoperative cerebrospinal fluid leak, gross tumor resection, use of nasoseptal flap), and endocrine remission did not significantly impact QOL (p > 0.05 for all variables). Conclusions: Our study demonstrated that patients who underwent endoscopic pituitary lesion resection maintained high nasal- and tumor-related quality of life over a 5-year follow-up period. However, given the limitations of our study, further multi-center studies with larger patient populations are warranted to validate these results.

Effect of Y-shaped Nasal Columella Made of Autologous Cartilage in Secondary Nasal Deformity after Cleft Lip Surgery.

Due to the diversity and complexity of tissues involved in secondary nasal deformities following unilateral cleft lip, secondary nasal deformity correction surgeries are challenging and often yield unsatisfactory results, posing a difficult problem for plastic surgeons. Autologous cartilage, with its low sculpting difficulty, minimal absorption, and stable tissue compatibility, is considered the optimal material for reconstructing the columella, nasal tip, and alar. This study analyzed the clinical outcomes of using autologous cartilage to create a Y-shaped columella to correct secondary nasal deformities after cleft lip surgery. In this retrospective study, 75 patients with secondary nasal deformity after unilateral cleft lip surgery were treated from January 2018 to December 2023. Appropriate costal cartilage, auricular cartilage, and iliac crest cartilage were fashioned into Y-shaped stents and implanted into the nasal columella of the patients to strengthen the tip cartilage. The free alar cartilage was sutured and fixed with a Y-shaped bracket. The wound healing rate, subjective satisfaction evaluation, and complications were analyzed. The nasal appearance, nasal deformity classification, and objective indices of healthy and affected nasal sides, function, and quality of life were compared before and after the operation. All patients healed well during the first stage without related complications, and the average incision healing time was 5.16 ± 1.37 days. The scores of nasal tip position, nasal tip shape, nostril shape, nasal dorsum shape, and nasal floor shape at 6 months post-operation were significantly lower compared to pre-operation (p < 0.001). The grade of nasal deformity at 6 months post-operation was lower than the pre-operation (p < 0.001). Pre-operation, the nasal base and nasal width of the affected side were higher than those of the healthy side, while the nasal columellar and nostril height were lower (p < 0.001). At 6 months post-operation, the nasal base and nasal width decreased, and the nasal columellar and nostril height increased (p < 0.001), with no significant difference between the two sides (p > 0.05). The nasal obstruction symptom evaluation (NOSE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) scores at 6 months post-operation were significantly lower than pre-operation, while the rhinoplasty outcome evaluation (ROE) score was higher (p < 0.001). The total patient satisfaction was 97.33% (73/75). Y-shaped nasal columella made of autologous cartilage can effectively correct secondary nasal deformity after cleft lip surgery, improve nasal alar collapse, lengthen nasal columella, elevate nasal end, enhance the quality of life, nasal appearance, and nasal ventilation function of patients, with high satisfaction and few complications.

Surgical Management of Moderate Rhinophyma with Nasal Nodules: An Electrosurgery Approach

Introduction: Rhinophyma, a severe manifestation of rosacea, is characterized by hypertrophy of sebaceous glands and fibrosis of the nose, often leading to significant aesthetic and functional impairments. Surgical treatment is the preferred approach for advanced cases to restore nasal appearance and function. Case Report: We present the case of a 60-year-old man with moderate rhinophyma and nodules on the nostrils. Surgical management under local anesthesia involved the use of thermal loops for excision of the lesions and bipolar electrosurgery for hemostasis. The patient was also treated for rosacea with topical agents, including metronidazole and azelaic acid, and oral doxycycline for inflammatory lesions. Directed healing followed the surgery, along with LED phototherapy and ablative erbium laser sessions to optimize results. Discussion: The use of thermal loops and electrosurgery allowed for precise excision and control of bleeding. Postoperative care, including daily greasy vaseline dressings, facilitated rapid healing. Mild infection at the excision sites was treated with topical and prophylactic antibiotics. Six sessions of LED therapy combining four types of light (infrared, red, yellow, and blue) improved healing and reduced inflammation. Ablative erbium laser was proposed to further enhance the aesthetic outcome. Conclusion: A combined surgical approach and careful postoperative management yielded satisfactory results in the treatment of rhinophyma.

Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function.

Endoscopic endonasal Trans-sphenoidal surgery for sellar-suprasellar tumors is considered the preferred route. The ideal instruments in skull base surgery should be able to manipulate adequately through the narrow corridors with effective tissue removal and bleeding control and reduce collateral damage to nearby vital structures. The present study sought to compare the nasal morbidity following transnasal sphenoidal surgery for pituitary macroadenoma using Coblation and Electrocautery. 160 undergoing Endoscopic TSS for non-functioning PAs were enrolled. The patients were randomly allocated into Coblation (n = 80) and electrocautery (n = 80) groups. All operations were performed by the same group of surgeons skilled in their surgical techniques. There were 59 and 53 patients with Knosp grade II tumors in the cautery and coblation group, respectively, while 21 and 27 patients had Knosp grade III tumors. The average duration of surgery using cautery was 96+/-4.5min, while with coblation, the average time was 83+/-3.5min, and the difference was statistically significant. Nasal crusting and granulation severity were observed more in the electrocautery group. The coblation group patients had clear surgical fields with few ooze points; the difference between the two groups was significant. Nasal synechiae and decreased nasal patency were common in the electrocautery group. There were no statistical differences in nasal bleeding, nasal deformity, or sense of smell parameters. Advanced medical tools like coblation are safe and effective for the dissection and ablation of the mucosa. They result in better intra-operative visualization and lesser postoperative nasal morbidity, which will help patients achieve a better quality of life.

The value of objective methods for assessing nasal breathing function in the diagnostic algorithm for allergic rhinitis

The visual analogue score (VAS) is recommended to assess the severity of symptoms of allergic rhinitis (AR), but despite its advantages, it is a tool for subjective assessment of symptoms and often does not correlate with the true state of nasal patency. Anterior active rhinomanometry (AAR) is the method to objectify obstructive changes in the nasal cavity in patients with AR and is the most accurate method to assess nasal breathing function from a physiological and aerodynamic point of view. In addition, AAR with a decongestant test allows a differential diagnosis of the causes of nasal obstruction. Our study showed that there was no correlation between VAS and AAR scores. In addition, we found the importance of performing AAR with a decongestant test and subsequent assessment of unilateral flow and resistance parameters, which allowed us to suspect the presence of structural changes in the nasal cavity in patients with AR, as recorded as a result of anterior rhinoscopy and/or endoscopic examination. Thus, in addition to the use of VAS, it is necessary to include AAR in the diagnostic algorithm for AR, which allows not only to confirm the presence or absence of nasal breathing impairment, but also to differentiate the causes of its occurrence for the subsequent selection of the optimal management of patients with AR.

Association Between Deviated Nasal Septum and Function of Eustachian Tube among Patients Attending a Tertiary Care Center

Deviated nasal septum is the most common cause of severe and chronic nose blockage. The eustachian tube (ET) is a tube that connects the middle ear cavity and the nasopharynx and provides middle ear ventilation. The relationship between DNS and ETF is controversial in medical literature. This study tried to find the association between deviated nasal septum and function of eustachian tube. This prospective study was conducted in Nepal Medical College Teaching Hospital, Otorhinolarynology Department from November 2022 to October2023 after acquiring ethical clearance from Institutional Review Committee. All the patients presenting to the outpatient clinic over the age of 19 with deviated nasal septum (DNS) were included. Statistical analysis was done using SPSS. A p value of &lt; 0.05 was considered statistically significant. Our study had 71 males (54.6%) and 59 females (45.4%) with mean age 37.2±15.9 years. Of 130 patients, 56 (43.1%) had DNS to right side while 74 (56.9%) to left. All patients had moderate DNS. Age group, gender, and laterality of DNS of the patient did not show any significant association with ETDQ7 score, tympanograms and middle ear pressures on either side. Moderate DNS did not affect ETF in a significant way.

The effect of maxillary sinus floor elevation with lateral antrostomy approach on nasal mucociliary functions.

It is aimed to evaluate the effect of maxillary sinus elevation with lateral antrostomy approach on mucociliary functions using the saccharin test. The study was planned prospectively. 29 patients who underwent maxillary sinus elevation were included in the study. The age and gender information of the patients were noted. Saccharin test was performed in the nasal cavity on the operated side. Mucociliary functions were evaluated with the results of the saccharin test performed before the operation and the saccharin test results at the 1st week, 1st month, and 3rd month postoperatively. Comparisons were made with these values. The mean age of the patients was 42.10 ± 4.99 years. Of the patients, 14 (48.3%) were female and 15 (51.7%) were male. Preoperative saccharine test results were found to be significantly lower than the postoperative values. As the postoperative recovery period increased, a significant decrease was observed in the saccharin test results. However, preoperative values were within normal limits, while postoperative values were above the normal range. In our study, it was observed that mucociliary functions improved as the postoperative period increased in patients who underwent maxillary sinus elevation, but were still above normal limits.

Quantitative measurement of the flow depending nasal valve function by elastography with electro-optical distance sensors. A pilot study

Nasal valve function depends on the intensity of the inspiratory nasal airflow, the geometry of the nasal entrance and the mechanical properties of the lateral nasal wall. It is desirable to obtain objective information on the relation between flow and valve movement. In this study, the deflection of the lateral nasal wall and the inspiratory flow were measured on 30 healthy volunteers, aged 18 to 82 without a history of severe trauma or nasal surgery. Electro-optical distance sensors were housed under a full-face protective mask attached to an analogue inspiratory flowmeter. The mean values for normal breathing were assessed at 675 [cm3/s] for the bilateral flow and −0.57 mm for the total movement. With forced breathing, the mean values for the flow of both nostrils were found to be 1434 cm3/s and for the total movement −1.21 mm. Statistically significant differences between normal and forced breathing were found in all participants and in both sexes, but no significant correlation by age. Electro-optical distance measurement, representing a novel technical way for the ‘elastography’ of the nasal valve should be added to advanced 4-phase-rhinomanometers.

Astodrimer sodium nasal spray forms a barrier to SARS-CoV-2 in vitro and preserves normal mucociliary function in human nasal epithelium

COVID-19 remains a severe condition for many including immunocompromised individuals. There remains a need for effective measures against this and other respiratory infections, which transmit via virus-laden droplets that reach the nasal or oral mucosae. Nasal sprays offer potential protection against viruses. Such formulations should preserve normal nasal mucociliary function. The antiviral barrier efficacy and effects on mucociliary function of astodrimer sodium nasal spray (AS-NS) were evaluated and compared with other available nasal sprays—low pH hydroxypropyl methylcellulose (HPMC-NS), iota-carrageenan (Carr-NS), nitric oxide (NO-NS), and povidone iodine (PI-NS). Assays simulated clinical conditions. Antiviral barrier function and cell viability were assessed in airway cell monolayers, while a model of fully differentiated human nasal epithelium (MucilAir™) was utilized to evaluate tissue integrity, cytotoxicity, cilia beating frequency, and mucociliary clearance. AS-NS reduced infectious virus in cell monolayers and demonstrated a benign cytotoxicity profile. In human nasal epithelium ex vivo, AS-NS had no impact on mucociliary function (cilia beating nor mucociliary clearance). Carr-NS, HPMC-NS, NO-NS and PI-NS demonstrated limited antiviral effects, while HPMC-NS caused inhibition of mucociliary function. Astodrimer sodium nasal spray demonstrates an acceptable nonclinical efficacy and safety profile as a barrier nasal spray against respiratory viral infection in the nasal cavity.

The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. This retrospective, double-blind study was conducted at Tekirdağ Namık Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The importance of otorhinolaryngology in correcting rhinoplasties with adverse events

Introduction: Rhinoplasty is a complex intervention aimed at enhancing both nasal aesthetics and functionality. The literature underscores the occurrence of adverse events in this procedure, prompting the search for effective correction strategies. In this context, otorhinolaryngology plays a crucial role, with a fundamental need to comprehend the incidence and types of complications to improve clinical practices. Methods: A systematic literature review was conducted to identify studies addressing adverse events in rhinoplasties and the role of otorhinolaryngology in their correction. The consulted databases included PubMed, Scopus, SciELO, Cochrane Library, LILACS, and Embase. Keywords such as "Rhinoplasty," "Otorhinolaryngology," "Adverse events," "Aesthetic outcomes," "Functional outcomes," "Nasal surgery," and "Complications in rhinoplasty" were combined using boolean operators "OR" and "AND." Results: The compiled results reveal a variety of adverse events in rhinoplasties, ranging from aesthetic complications to functional challenges. The analysis underscores the importance of a specialized otorhinolaryngological approach in minimizing these adverse events, emphasizing the need for treatment personalization to optimize outcomes. Conclusion: It is concluded that otorhinolaryngology plays an essential role in correcting adverse events in rhinoplasties. The systematic review highlights the complexity of these interventions, emphasizing the necessity of a multidisciplinary and specialized approach to achieve satisfactory aesthetic and functional outcomes. These findings support the significance of the otorhinolaryngologist's role in optimizing the quality of care provided to patients undergoing rhinoplasties.

Correlations of pre- and post-operative symptoms with cytokines in different phenotypes and endotypes of chronic rhinosinusitis.

Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and post-operative symptoms with cytokine positivity in different endotypes and phenotypes of CRS. In total, 102 patients undergoing routine functional endoscopic sinus surgery were enrolled. The endotype classification (type 1, 2, or 3 CRS) was defined based on positivity for interferon-γ, interleukin (IL)-5, or IL-17 respectively, in sinonasal tissue samples. Clinical symptom scores were evaluated pre- and post-operatively using the 22-item Sinonasal Outcome Test and its four symptom subdomains: sleep, nasal, otologic/facial symptoms, and emotional function. Symptoms were compared between endotypes and phenotypes, and exploratory factor analysis (EFA) based on principal component analysis (PCA) was performed. The correlations of cytokine levels with baseline symptoms and changes in symptoms after 1 year were analysed. Symptoms in the otologic/facial pain category were associated with non-type 2 endotypes in PCA and confirmatory analysis. Non-type 2 CRS patients exhibited significantly more improvement in facial symptoms 1 year after surgery. Neutrophil-associated cytokines, such as IL-17, matrix metalloproteinase 9, and myeloperoxidase, were significantly correlated with baseline otologic/facial pain symptoms and changes in those symptoms after surgery. Otologic/facial pain symptoms may be indicative of non-type 2 endotypes. Neutrophil-associated cytokines, such as IL-17, MMP-9, and MPO, were significantly correlated with these symptoms. The establishment of links between specific symptoms and certain cytokines may help use and develop biological therapies for CRS.

Application of free forearm flap in reconstruction of postoperative defect of external nasal malignant tumor

Objective:To investigate the therapeutic effect of free forearm flaps in repairing the postoperative defect of external nasal malignant tumor. Methods:Six patients with nasal malignant tumor were treated with radical operation of external nasal malignant tumor and simultaneous reconstruction of external nasal defects with free forearm flap. Preoperative Allen experiment, ultrasonic Doppler blood flow meter or CT angiography confirmed that the forearm blood vessels were in good condition. Results:The free forearm flaps were obtained from six patients, and completely survived. During the follow-up period of 6-12months, all patients had good external nasal morphology, good nasal function, no nasal obstruction and anterior nostril stenosis, no obvious complications in donor hand and no local cancer recurrence. Conclusion:The free forearm flap is a reliable method to reconstruction the postoperative defect of external nasal malignant tumor, with a high success rate and good recovery of morphology and function recovery.

Unveiling the Impact of Three-Dimensional Technology on Rhinoplasty: A Systematic Review and Meta-analysis.

This study aimed to investigate the impact of three-dimensional (3D) technology on preoperative evaluation for rhinoplasty.A systematic search was conducted on Embase, MEDLINE, and Web of Science. Studies that utilized 3D technology in preoperative assessment for rhinoplasty were included. The primary outcome was surgeon and patient satisfaction. The secondary outcomes included nasal function, cost-efficiency, reoperation rate, precision, and surgical time.Twelve studies (595 patients) were included. Surgeons reported higher satisfaction with 3D approaches based on precision and postoperative results. Patients expressed satisfaction with the 3D approaches due to a better understanding of the procedure and the ability to discuss with the surgeons planning the procedure and participating in postoperative design. The 3D approaches demonstrated higher surgeon satisfaction (mean difference -0.13, 95% confidence interval [CI] -0.20 to -0.06, p = 0.0002), particularly in revision cases, and provided higher precision compared with the two-dimensional (2D) approaches. However, 3D technology was more expensive and not cost-efficient. There were no significant differences in reoperation rate (odds ratio 0.16, 95% CI 0.02-1.36, p = 0.09) and surgical time. Postoperative nasal function showed inconsistent results.3D technology offered higher surgeon satisfaction and increased precision compared with 2D imaging. However, 3D imaging was expensive and not cost-efficient. Reoperation rate and surgical time were comparable, while postoperative nasal function outcomes showed inconsistent results.