Nasal Obstruction Septoplasty Effectiveness Research Articles

A comparison of symptoms and quality of life between medial flap and coblation turbinator of inferior turbinate reduction in endoscopic septoturbinoplasty: an analysis of 108 cases.

The combination of septoplasty and turbinoplasty is a common surgical and accepted intervention to correct the nasal obstruction. The coblation submucosal reduction turbinator is a new surgical device, and it started to be used recently. On the other hand, the medial flap inferior turbinoplasty is not a conservative technique, but it provides a reliable and robust reduction. This study aims to compare the symptoms as well as health-related quality of life (HQOL) in 55 patients who underwent septoplasty with concomitent medial flap inferior turbinoplasty (group 1), 53 patients who patients underwent septoplasty with concomitent coblation turbinator (group 2). The authors performed a prospective, randomized study of 108 patients who consulted the otorhinolaryngology department at the university hospital for surgery of septoturbinoplasty. Preoperatively, the two patient groups had quite similar symptoms and health-related quality of life, and the anterior width of the inferior turbinate showed significant differences between the contralateral and deviated sides but not the posterior part. The significant difference (P<0.05) was noted for postoperatively improved symptom scores on visual analogue scale (VAS), nasal obstruction septoplasty effectiveness (NOSE) and better HQOL [Sino-Nasal Outcome Test-22 (SNOT-22)] in all patient groups. In addition, the NOSE and SNOT-22 scores in group 2 had significantly greater improvement than group 1 (P<0.05). Septoturbinoplasty treatment of septum deviation and inferior turbinate hypertrophy led to less symptoms as well as better HQOL for all two patient groups. Therefore, these techniques were an effective intervention for turbinate reduction, and they are equally efficient in the long term.

Subjective assessment of the effect of septoplasty on respiratory and voice functions

To assess the impact of septoplasty on quality of life by measuring changes in nasal breathing and voice function using subjective assessment questionnaires. The study included 98 patients who underwent septoplasty for the nasal septum deviation. The effect of the operation on nasal breathing was assessed subjectively using the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and the effect on voice function was assessed using the Voice Handicap Index-30 (VHI-30) questionnaire. There was a statistically significant difference between the preoperative and postoperative (after 1 and 3 months) NOSE data (in both cases, p<0.001) and and between the indicators 1 and 3 months after surgery (p<0.001). There was a statistically significant difference (p<0.001 in both cases) between the preoperative VHI-30 and 1 and 3 months postoperatively. There was also a statistically significant difference (p<0.001) between 1 and 3 months after surgery for this test. In this study, the effect of septoplasty on respiratory and voice function was demonstrated using subjective tests. In the postoperative period, patients subjectively positively assessed changes in both nasal breathing and voice.

Quick septoplasty in children: Long-term effects on nasal breathing and dentofacial morphology. A prospective cephalometric study

ObjectiveMany authors have investigated the most appropriate surgical approach to the deviated septum in childhood, considering the obligate mouth-breathing habit a possible cause of malocclusion and disharmonious development of the facial skeleton in growing kids. Nevertheless, controversies still remain about the long-term functional/esthetic results of such procedures, mainly due to the duration of the follow-up and possible confounding factors. Methods111 Caucasian children (age range: 6–13 years) were submitted to a personal “Quick” septoplasty surgical technique between 2005 and 2010. Preoperative otorhinolaryngological examination using flexible nasal endoscopy, anterior active rhinomanometry (AAR), Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and dentofacial evaluation (including cephalometry) were performed. Postoperative AAR, NOSE questionnaire and cephalometric assessment were carried out in all patients at the age of 18 years. Informed consent was obtained from children's parents as appropriate. ResultsNo surgical complication was recorded. Among our patients, a significant (p <0.001) improvement of nasal breathing resistances at AAR and NOSE questionnaire scores was found after surgery. A significant improvement in cephalometric/dental parameters (gonial angle values, anterior facial height, prevalence of class I occlusion, maxillary intermolar width, and cross-bite frequency) was noticed after the follow-up with respect to preoperative conditions. ConclusionThe “Quick” septoplasty technique described is a practical and conservative procedure with a low complication rate that offers long-term favourable results for the correction of nasal septum deviations in children. Nasal-breathing restoration may favor a physiological and harmonious development of craniofacial and dental structures in offspring.

The Relationship of Preseptoplasty and Postseptoplasty Early Period Comfort Level With Nasal Obstruction, Sleep Quality, and Fatigue Severity: A Prospective Study

PurposeThe aim of this study was to compare the comfort level, nasal obstruction, sleep quality, and fatigue of patients with septal deviation preseptoplasty and postseptoplasty. DesignA prospective study conducted on 65 patients diagnosed with septal deviation. MethodsThe data of the study were collected using an Introductory Information Form, a Short General Comfort Questionnaire, the Pittsburgh Sleep Quality Index, the Fatigue Severity Scale, and the Nasal Obstruction Septoplasty Effectiveness Scale. Linear regression was performed to evaluate the extent of the relationship of predictors affecting the comfort level. FindingsThere was a statistically significant difference between the scores in the preoperative period and postoperative weeks 4 and 12. It was found that patients' use of sleeping medication, nasal obstruction, fatigue, and subjective sleep quality were the primary predictors of comfort levels in the preoperative period. In the postoperative week 4, comfort level predictors were daytime dysfunction and subjective sleep quality. Daytime dysfunction and working conditions were the predictors of comfort level in the postoperative week 12. ConclusionsMany physical problems, such as nasal obstruction, fatigue, and sleep disorders were detected in patients before septoplasty. This study revealed the importance of performing septoplasty before sleep quality reaches a pathologic level or requires a sleep medication.

Endoscopic "Quick" Septoplasty in Preservation Rhinoplasty.

Preservation rhinoplasty (PR) is revolutionizing rhinoplasty surgery, based on new anatomical studies, advanced tip suture techniques, and refinement of surgical techniques. Septal surgery is a fundamental preparatory stage during PR, especially for the dorsal preservation let/push-down procedure. To increase the predictability of the septoplasty aesthetic effects on the nasal dorsum and further extend the principles of PR to septal surgery, we applied the endoscopic technology to the "quick" septoplasty technique we had already developed in the past decades. One hundred sixty-six patients (41 males, 125 females; mean age, 39.7 years; age range, 18-61 years) were submitted to endoscopic "quick" septoplasty for septal deviation during PR procedure. Preoperative evaluation of the nasal dorsum included external examinations of the size, shape, and orientation of the dorsum. Anterior active rhinomanometry was performed in all patients to determine nasal flow resistance preoperatively and 6 months after surgery. Preoperative and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness questionnaire were compared to assess the improvement of nasal symptoms after surgery. The duration of the septoplasty procedure was measured for all the patients. Standard nasal photographic assessment was performed before and 6 months after surgery. Postoperatively, 98.8% of our patients displayed an improvement of their nasal breathing function. No complication in terms of septal perforation, nasal infection, or bleeding was noticed. No case of turbinoseptal synechiae or cerebrospinal fluid leak was recorded. The dorsum preservation rhinoplasty procedure was successfully completed in all patients. The mean septoplasty operative time, excluding local anesthesia injection and other surgical procedures associated with septal surgery such as turbinoplasty and rhinoplasty, was 11.41 ± 6.23 minutes (range, 9-31 minutes). Our results show that a short surgical time is needed to perform the proposed endoscopic septoplasty procedure. Such a short operative time allows the physician to both correct septal deviations quickly and correct/reduce the cartilaginous hump, thus representing a fundamental element of PR. In addition, the minimal tissue dissection reduces intraoperative nasal edema, favoring intraoperative aesthetic evaluation.

Severe deviated nose treatment: importance of preserving the dorsal septal remnant.

To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose. In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015-April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale). In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p = 0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group. Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction using Objective and Subjective Methods.

Introduction Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely. Objective The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients. Methods This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36 months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL. Results There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased. Conclusion The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.

A systematic review of patient-reported outcome measures after rhinoplasty

The literature still lacks a review regarding PROs applied for rhinoplasty. Thus, we performed a systematic review of the literature to identify PROMs that assess patient satisfaction and quality of life after rhinoplasty. The aim of our study was to identify existing questionnaires and to summarize their development, psychometric properties, and content. A multi-step search of the web-based PubMed database from the National Library of Medicine was performed to identify PROMs that are designed to evaluate satisfaction and quality of life following rhinoplasty. Each potential PROM was examined by three independent reviewers for adherence to inclusion/exclusion criteria. Questionnaires included in the analysis were appraised for their adherence to international guidelines for the development and validation of health outcome questionnaires, as outlined by the Scientific Advisory Committee of the Medical Outcome Trust and the U.S. Food and Drug Administration. Our search generated a total of 457 articles, 351 that were retrieved in the primary search, and 106 that were found in the references of the first set of articles. The process of development and validation of each of the included PROMs was examined. Only ten of these were identified as surgery-specific questionnaires about rhinoplasty. These were divided into three categories: (1) functional self-assessment (Nasal Surgical Questionnaire, Nasal Obstruction Symptoms Evaluation Scale, and Nasal Obstruction Septoplasty Effectiveness); (2) aesthetic self-assessment (Utrecht Questionnaire, FACE-Q rhinoplasty module, Glasgow Benefit Inventory); and (3) aesthetic and functional self-assessment (Rhinoplasty Outcomes Evaluation), Functional Rhinoplasty Outcome Inventory 17, RHINO Scale, and Evaluation of Aesthetic Rhinoplasty Scale).

Anterior Septal Reconstruction for Treatment of Severe Caudal Septal Deviation: Clinical Severity and Outcomes.

To report the long-term efficacy of a modified extracorporeal septoplasty technique in the treatment of anterocaudal septal deviations. Case series with chart review. Academic tertiary care medical center. Data were obtained by a retrospective review of patients treated by a single surgeon (S.P.M.) from December 2010 to April 2014. A total of 77 patients (52 male, 25 female) met inclusion criteria. The Nasal Obstruction Septoplasty Effectiveness (NOSE) scale and a visual analog scale (VAS) were administered to all patients preoperatively and at each postoperative visit. Statistical analysis was performed using a matched-pair t test comparing preoperative and postoperative NOSE and VAS scores. A recently described severity scale for nasal obstruction was applied to NOSE scores to demonstrate postoperative results. Average follow-up was 4.7 months. Average preoperative NOSE and VAS scores were 68.2 ± 17.4 and 7.2 ± 1.8, respectively, placing these patients in the "severe" symptoms classification. Average NOSE and VAS scores in the early postoperative period (1-3 months after surgery) were 21.1 ± 19.8 (P < .0001) and 2.1 ± 2.6 (P < .0001), respectively. Average NOSE and VAS scores in the late postoperative period (>3 months after surgery) were 15.8 ± 19.0 (P < .0001) and 1.4 ± 1.8 (P < .0001), respectively. Both early and late postoperative NOSE scores represented "mild" symptomatology. Anterior septal reconstruction represents a powerful method for correction of nasal valve stenosis resulting from severe anterocaudal septal deviations.

Patient‐specific aided surgery approach of deviated nasal septum using computational fluid dynamics

In treating a patient with deviated nasal septum (DNS), a surgeon draws up a surgical plan based on the patient's rhinomanometry outcomes and self‐assessment of nose conditions, e.g. the nasal obstruction septoplasty effectiveness (NOSE) score. However, the procedure fails to localize the DNS and determine the nose's aerodynamic effects. This paper proposes a DNS‐aided surgery approach using computational fluid dynamics (CFD) and computed tomography (CT) techniques consisting of three main processes: preoperative, presurgical planning, and postoperative processes. The healthy baseline refers to a benchmark consisting of five subjects without DNS and nasal airway obstructions. To assess the possibility of using the CFD‐CT‐aided surgery approach as a presurgical planning tool in the DNS operation, comparative tests were carried out with DNS patient #1, who received a conventional nasal surgery without the proposed presurgical planning. Although DNS patient #1's surgical outcome was relatively satisfying to the patient, evaluating from the reduction of the NOSE score the conventional surgical method could induce an excessive excision of nasal airway, resulting in water loss in the nasal mucosa and a large reduction in airflow velocity. In addition, the postoperative nasal resistance measured by a rhinomanometer was not acceptable to the surgeon. Virtual surgery using the CFD‐CT approach performed after surgery could suggest suitable patient‐specific components of nasal operation with predictable results. Subsequently, implementation of the proposed CFD‐CT approach in aid of DNS surgery was performed in DNS patient #2. The benefits of the CFD‐CT‐aided surgery approach were determined based on the pre‐ and postoperative outcomes (i.e. nasal geometric data and nasal airflow patterns), NOSE scores, and rhinomanometric data of DNS patient #2, which were compared against those of the healthy baseline benchmark. The CFD‐CT approach could assist the surgeon to localize the DNS and determine the defective nasal tissues to be removed. The actual postoperative outcomes were clinically acceptable to the surgeon and DNS patient #2. It is evident that the CFD‐CT‐aided surgery approach is suitable for and applicable to surgery of DNS patients with small variability from the presurgical planning stage. © 2015 Institute of Electrical Engineers of Japan. Published by John Wiley &amp; Sons, Inc.

Effects of nasal pack use on surgical success in septoplasty.

This study aims to evaluate the effects of nasal packs on surgical success and related complications in septoplasty. Thirty-eight patients (21 males, 17 females; mean age, 36.6 years, range 18 to 61 years) were included in the study. Septoplasty candidates were prospectively divided into two groups. Nasal packing and transseptal suture technique was applied to patients in group 1 (n=16) and group 2 (n=22), respectively. Postoperative pain was assessed with the visual analog scale. The success of surgery was questioned using the Nasal Obstruction Septoplasty Effectiveness (NOSE) scale. Surgical success was defined as a 50% decrease in the NOSE scores. There was no statistically significant difference in surgical success and complication rates between the groups (p>0.05). Pain scores were significantly higher in group 1 (p=0.015). Our study results suggest that nasal pack use does not affect surgical success and complication rates in septoplasty. Pack-free septoplasty with the transseptal suture technique is an effective method in the treatment of septal deviation.

Patients` evaluation for the surgical management of nasal obstruction

Statement of problem: Surgery for nasal obstruction is performed to give a subjective benefit. We aimed to evaluate the surgical management of the nasal obstruction in the patient`s perception. Methods of study: The study was performed prospectively with 134 patients over the age of 18. They were allotted to three groups according to the level of nasal obstruction by clinical examination. The G1 group had only a deviated nasal septum (DNS), G2 had DNS and hypertrophy of inferior turbinates, and G3 had nasal valve problems in conjunction with DNS. All the patients had surgery focused on obstructive pathologies. The study was conducted using three different scoring systems to determine the patients` evaluation of the surgical procedures. Results: The study included more man than woman, with a mean age around 28 (wide range). Twenty six patients were in G1, 73 patients in G2 and 35 patients in G3. Total and general Glasgow Benefit Inventory (GBI) scores for each group showed improvement postoperatively. There was a significant difference between the groups for general GBI score, and Post-hoc test showed that the improvement of G1 was greater than of G3. The influence of the surgery on physical health, psycho-social function and social interaction scores for each group showed no changes postoperatively. There was a significant improvement in all Nasal Obstruction Septoplasty Effectiveness (NOSE) scores and Likert Scale scores for each group. The improvement of G1 and G2 were greater than G3 on the Likert Scale. Conclusion: Surgical management targeted to the region of obstruction improves symptoms and benefit in the patient`s perception.

Patients’ evaluation for the surgical management of nasal obstruction

Surgery for nasal obstruction is performed to give a subjective benefit. We aimed to evaluate the surgical management of the nasal obstruction in the patient`s perception. The study was performed prospectively with 134 patients over the age of 18. They were allotted to three groups according to the level of nasal obstruction by clinical examination. The G1 group had only a deviated nasal septum (DNS), G2 had DNS and hypertrophy of inferior turbinates, and G3 had nasal valve problems in conjunction with DNS. All the patients had surgery focused on obstructive pathologies. The study was conducted using three different scoring systems to determine the patients` evaluation of the surgical procedures. The study included more man than woman, with a mean age around 28 (wide range). Twenty six patients were in G1, 73 patients in G2 and 35 patients in G3. Total and general Glasgow Benefit Inventory (GBI) scores for each group showed improvement postoperatively. There was a significant difference between the groups for general GBI score, and Post-hoc test showed that the improvement of G1 was greater than of G3. The influence of the surgery on physical health, psycho-social function and social interaction scores for each group showed no changes postoperatively. There was a significant improvement in all Nasal Obstruction Septoplasty Effectiveness (NOSE) scores and Likert Scale scores for each group. The improvement of G1 and G2 were greater than G3 on the Likert Scale. Surgical management targeted to the region of obstruction improves symptoms and benefit in the patient`s perception.

Antibiotics in septoplasty: Evidence or habit?

Antibiotic prophylaxis for surgical procedures is a common practice among otorhinolaryngologists. Most American Rhinology Society members use antibiotics routinely in septoplasties, even though the need for this practice in rhinological surgery is controversial. This study was designed to assess the necessity of antibiotic prophylaxis in septoplasties in relation to surgical outcome and postoperative complications. In a prospective randomized clinical trial we evaluated 630 subjects who underwent septoplasty according to the technique already described by the authors. Patients were divided into three groups: group A, no antibiotic prophylaxis; group B, antibiotics (cefazolin at 1.0 g i.v.) only at anesthetic induction; group C, antibiotics both at anesthetic induction (cefazolin at 1.0 g i.v.) and postoperatively (oral amoxicillin at 1 g every 12 hours) for 7 days. Pre- and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire were compared to assess the improvement of nasal symptoms after surgery. Postoperative pain, nasal bleeding, septal hematoma/abscess, fever, and nausea/vomiting were recorded. Nasal endoscopy was performed 14 days postoperatively to quantify purulent rhinorrhea. An improvement of postoperative nasal symptoms on the NOSE questionnaire was recorded with respect to preoperative score. No significant difference was found among the groups with regard to postoperative pain, fever, nausea/vomiting, and nasal bleeding. No case of hematoma or septal abscess was noticed. No significant difference in purulent nasal discharge was found among the groups. Septal surgery with early removal of nasal packing is a clean-contaminated procedure and does not require routine antibiotic prophylaxis because of the low infection risk.

Trends in functional rhinoplasty 2008

This article reviews the recent literature on functional rhinoplasty for the most important contributions in the field. Surgical techniques for improving the internal nasal valve include upper lateral cartilage fold-in flap, splay graft, alar batten graft, Z-plasty, and the alloplastic Monarch implant. The Nasal Obstruction Septoplasty Effectiveness (NOSE) score and the Rhinoplasty Outcomes Evaluation score have been applied to objectify outcomes in functional rhinoplasty. Functional endoscopic sinus surgery (FESS) and rhinoplasty continue to be safely used in the same surgical sitting. The last few years have seen improved perspective on what surgery can do, substantiating the inherent difficulties of establishing reproducible outcomes in form and function of the nose.

Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study

The goal of this study was to compare the outcome of septoplasty in our patients with previous reports. We found some different outcomes of septoplasty at our center compared with the reports in the literature. One of the major differences between this and previous studies is in the mean age of patients undergoing surgery, 22.44 years in our study vs more than 40 years in most studies. In this study, 86 patients with septal deviation were asked using an outcomes instrument (the Nasal Obstruction Symptom Evaluation scale) before and 3 and 6 months after septoplasty. Seventy-seven patients (89.5%) reported a subjective improvement in their nasal obstruction, which is more than the experience of most authors. There was a significant improvement in mean Nasal Obstruction Symptom Evaluation score at 3 months after septoplasty, and some symptom improvement continued to 6 months. We conclude that younger patients who have nasal obstruction with septal deviation benefit more from septoplasty.

Trends in Functional Rhinoplasty

The evolution of the rhinoplastic surgery has spanned several centuries, with the last few decades focused on the development and refinement of techniques that address the nasal airway specifically. This increased focus on functional rhinoplasty has led to significant improvements in our ability to preserve and augment the nasal airway. Techniques are generally categorized by their effects on the external and/or internal nasal valves. Limitations exist, however, in our ability to critically interpret and apply these techniques due to a dearth of validated and reliable outcomes measures as well as confusion regarding the nomenclature of the nasal valves. This chapter will present a brief introduction to the history of functional rhinoplasty, means of evaluating the nose, outcomes, and surgical treatment of the nasal airway during functional rhinoplasty.

Outcomes after nasal septoplasty: Results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study

Objective Our goal was to assess disease-specific quality of life outcomes after nasal septoplasty in adults with nasal obstruction. Design, settings, and patients We conducted a prospective observational outcomes multicenter study with 14 sites and 16 investigators, including private practice and academic settings. Patients had had septal deviation and symptomatic nasal obstruction for at least 3 months, and medical management had failed. Methods Patients with septal deviation completed a validated outcomes instrument (the Nasal Obstruction Septoplasty Effectiveness [NOSE] scale) before and 3 and 6 months after septoplasty, with or without partial turbinectomy. Results Fifty-nine patients underwent surgery; there was a significant improvement in mean NOSE score at 3 months after septoplasty (67.5 versus 23.1, P < 0.0001), and this improvement was unchanged at 6 months. Patient satisfaction was very high, and patients used significantly fewer nasal medications. Conclusions In patients with septal deformity, nasal septoplasty results in significant improvement in disease-specific quality of life, high patient satisfaction, and decreased medication use.