Nasal Obstruction Symptom Evaluation Scale Research Articles

Vertical Sectioning of the Cartilaginous Vault for Rhinoplasty: Technique and Assessment.

To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty. A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented. Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P < .001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P < .001), and both (57.9 ± 35.0-26.1 ± 20.2, P = .03). The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation.

Modern Aspects of Closed and Open Rhinoplasty (Literature Review)

Open and closed rhinoplasty are two primary approaches to nasal modification. According to the current literature, there is no consensus among plastic surgeons and otolaryngologists regarding the preferred method in terms of aesthetic outcomes, complications, and patient satisfaction. This review aims to analyze published scientific materials to determine whether open or closed rhinoplasty leads to more favorable patient outcomes. For this systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a literature search across four databases according to our search strategy. The articles were then imported into COVIDENCE, where they underwent primary screening and full-text review. A total of twenty studies were selected for this review after analyzing 243 articles. Among them, there were four case series, twelve retrospective cohort studies, one prospective cohort study, one case-control study, and two outcome studies. The analysis included three cosmetic studies, eight functional studies, and nine studies that addressed both cosmetic and functional components. Sixteen studies used both open and closed rhinoplasty techniques, while four focused exclusively on open rhinoplasty. Both methods demonstrated high satisfaction rates among patients and professionals, with no significant advantage found for either technique. Based on the available studies, we cannot conclude the superiority of either open or closed rhinoplasty in achieving better patient outcomes. Several studies indicated that both open and closed rhinoplasty resulted in comparable levels of patient satisfaction. To enhance the reliability and consistency of outcome reporting, authors should focus on using the Nasal Obstruction Symptom Evaluation (NOSE) scale and other standardized rhinoplasty outcome assessments.

Endonasal Thermal Imaging Before and After Nasal Airway Surgery.

Nasal airway surgery is often applied when treatment fails to relieve nasal obstruction. However, surgery that improves airflow does not always alleviate the symptoms of nasal obstruction. The perception of nasal breathing is likely more related to changes in mucosal temperature than the mechanical sensation of flow or pressure. This study aims to measure intranasal mucosal temperature pre-and post-surgery using endonasal thermal imaging, exploring its correlation with subjective nasal breathing and objective airflow measurements. A prospective study of adult patients with nasal obstruction managed with nasal airway surgery was performed. Intranasal mucosal temperatures were determined using the thermal endonasal image of the nasal passage produced by the infrared radiometric thermal camera (FILR VS290). A comparison was made between the mean values of mid-expiration (ExT) and mid-inspiration (InT) temperature data (internal nasal valve, nasal cavity, inferior turbinate, and overall airway [mean value]) and visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale and nasal airway resistance (NAR) before and after surgery. Seven patients (35.14 ± 16.45 years, 57.14% female) were included. All NOSE, VAS, and NAR improved after surgery (59.29 ± 10.89 vs 17.14 ± 14.64; P < .001, 64.50 ± 26.79 vs 18.57 ± 19.99; P < .001, 0.82 ± 0.48 vs 0.34 ± 0.11 Pa/cm3/s; P = .002, respectively). ExT, InT, and the difference between ExT and InT of three areas and overall airway were similar between pre-and post-surgery. No statistically significant correlations were found between intranasal mucosal temperature, VAS, NOSE, and NAR at pre-and post-surgery except for the difference between ExT and InT of overall airway and NOSE pre-operative (Pearson r = 0.57; 95% CI 0.06-1.09; P = .03). Endonasal thermal imaging can assess the intranasal mucosal temperature of a patient. However, more precise imaging of the nasal passages and data acquisition are required to establish mucosal temperature as an objective measure of nasal obstruction before and after nasal airway surgery in a clinical setting.

Engineered autologous nasal cartilage for repair of nasal septal perforations - a case series.

This phase I clinical trial assessed the use of autologous nasal chondrocyte tissue-engineered cartilage (N-TEC) for functional repair of nasal septal perforations (NSP). The most widely used technique to treat NSP, namely interposition grafting with a polydioxanone (PDS) plate combined with a deep temporal fascia (DTF) graft, is still suboptimal towards patient satisfaction and revision rates. Patients (n=5, all female, age range: 23-54 years) had a 0.5-2.0cm diameter NSP. N-TEC was manufactured by expansion and 3D culture of autologous nasal septum chondrocytes into Chondro-Gide® collagen membranes. N-TEC was then shaped intraoperatively and enveloped in the harvested DTF before suturing it into the NSP. Safety (primary outcome) was assessed by the number of serious adverse reactions (SAR) until 12 months. Secondary outcomes included feasibility, assessed by surgical graft manipulation, and efficacy, assessed using subjective scoring (Nasal Obstruction Symptom Evaluation, NOSE, and Visual Analogue Scale, VAS, scores) and objective breathing function tests. Structural closure of NSP after 12 months was defined using endoscopy and computed tomography (CT) scans. NSP treatment by N-TEC implantation was safe and feasible, as no SAR and no challenge in graft manipulation was recorded for any of the patients. One year postoperative, subjective scoring improved in all patients, unless already optimal (average improvement of 23 and 28.6 points out of 100 respectively for NOSE and VAS scores). Objective respiratory function overall confirmed - with the exception of one case - the observations above (average improvement of 172 ml/s). NSP were closed and the mucosae completely healed in three patients. Autologous N-TEC is a valid treatment for NSP and warrants further clinical tests.

Internal Nasal Valve Collapse Treatment by Endonasal Hyaluronic Acid Injection.

Internal nasal valve collapse (IVC) is a common functional complication of rhinoplasty and injecting hyaluronic acid is one of the treatment options available, but its effectiveness has never been evaluated. The objective of this study was to assess the evolution of IVC after injection of hyaluronic acid using objective and subjective measures of nasal obstruction. A prospective interventional study was conducted. Adult patients consulting for nasal obstruction after (septo)rhinoplasty and diagnosed with IVC were included. Patients underwent 4-phase rhinomanometry, completed nasal obstruction symptoms evaluation (NOSE) and visual analog scale (VAS) questionnaires and received hyaluronic acid injections. Measurements were repeated immediately, one month and one year later. The primary outcome measure was the proportion of patients below the rhinomanometric diagnostic threshold for IVC at one month. Among the 22 patients included, 20 (91%) had rhinomanometry measurements below the diagnostic threshold for IVC one month after injection. It decreased to 53% (8/15 patients) at one year post injection. The mean NOSE score decreased from 74.5 (± 18.0) before injection to 35.2 (± 23.3) after injection (p < 0.0001). The mean VAS score decreased from 7.0 (± 1.4) before injection to 3.4 (± 1.9) after injection (p < 0.0001). In these patients with post-(septo)rhinoplasty IVC, hyaluronic acid injection into the internal nasal valve substantially improved subjective and objective measures of nasal obstruction. These results suggest hyaluronic acid injection (performed as described) is an effective treatment for IVC and is an excellent alternative to surgical treatment. 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 https://www.springer.com/00266 .

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Middle Vault Dorsal Augmentation in Rhinoplasty as "Push-up" Preservation Technique or as "Modified Dorsal Split Extended Push-up" Procedure.

Primary or secondary dorsal augmentation rhinoplasty addresses aesthetic and functional issues related to a deficient, under-projected, or depressed nasal dorsum, frequently in middle vault. Traditional treatments often involve costal cartilage grafts, which can result in palpable irregularities and additional morbidity. Implementing dorsal preservation techniques in selected patients may improve predictability and outcomes of dorsal augmentation. We conducted a case series involving 12 patients with saddle nose deformities and significant nasal function impairment. All patients underwent either "push-up" preservation technique or "modified dorsal split extended push-up" technique. The techniques were evaluated for feasibility, safety, and efficacy. Functional outcomes were assessed using the nasal obstruction symptom evaluation (NOSE) scale preoperatively and three months postoperatively. Eight patients underwent "push-up" technique, and four patients required "dorsal split extended push-up" technique due to extensive scarring and mucosal adhesions from previous surgeries. All patients demonstrated significant postoperative improvement in nasal function as indicated by a reduction in NOSE scores (p < 0.05). Aesthetic outcomes showed a naturally augmented and smooth dorsum with no palpable irregularities. Patient satisfaction was rated very high (9 or 10 out of 10) in 10 patients and high (7 or 8 out of 10) in 2 patients. Follow-up was 6months. "Push-up" preservation technique and its extended variant provide a new surgical alternative for primary and secondary rhinoplasty with costal cartilage. These techniques offer improved and highly predictable aesthetic outcomes of the nasal dorsum with decreased morbidity, demonstrating significant potential for clinical practice and future research. 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 .

Comparing Patient-Reported Outcomes with Computational Fluid Dynamics-Derived Nasal Airflow After Nasal Airway Surgery: Prioritizing the Patient's Perception of Nasal Obstruction.

Background: Some patients report persistent nasal obstruction after surgical treatment despite objective improvement. Objective: To compare patients' perceptions of nasal obstruction after surgery with objective nasal airflow as determined by computational fluid dynamics (CFD) modeling: (1) Is perception driven by a more symptomatic side? (2) Can symptom improvement be predicted with CFD modeling? Methods: Pre/postoperative Nasal Obstruction Symptom Evaluation (NOSE) and visual analog scale (VAS) score were collected for patients undergoing nasal obstruction surgery. Pre/postoperative computed tomography was used to generate patient-specific airway models for CFD simulation at 15 L/min resting inspiration. Results: Ten patients (22-53 years, seven men and three women) underwent septoplasty, turbinate reduction, and/or rhinoplasty. Postoperative NOSE was most correlated with postoperative VAS score from the "affected" side (R2 = 0.59, p < 0.01), and postoperative NOSE was strongly predicted by a two-parameter model using parameters only from the "affected" side (R2 = 0.84, adjusted R2 = 0.80, p < 0.01). Conclusion: The postoperative state of the initially "affected" side drives outcomes after nasal obstruction surgery. Surgeries should prioritize improving the "affected" side. A two-parameter model using the VAS and nasal airflow from only the "affected" side strongly predicts NOSE and is promising for the future using virtual planning to individualize procedures to optimize outcome.

Oxymetazoline as a predictor of turbinate reduction surgery outcomes: Objective support from a prospective, single-blinded, computational fluid dynamics study.

A patient's subjective response to topical nasal decongestant is often used to screen for turbinate reduction surgery suitability. However, this anecdotal strategy has not been objectively and quantitatively evaluated. Prospective, longitudinal, and single-blinded cohort study employing computational fluid dynamic modeling based on computed tomography scans at baseline, 30min postoxymetazoline, and 2 months postsurgery on 11 patients with chronic turbinate hypertrophy. Nasal obstruction symptom evaluation (NOSE) and visual analogue scale (VAS) obstruction scores significantly improved from baseline to postoxymetazoline and again to postsurgery (NOSE: 71.82±14.19 to 42.27±25.26 to 22.27±21.04; VAS: 6.09±2.41 to 4.14±2.20 to 2.08±1.56; each interaction p<0.05), with significant correlation between the latter two states (r∼0.37-0.69, p<0.05). Oxymetazoline had a broader anatomical impact throughout inferior and middle turbinates than surgery (many p<0.05); however, the improvement in regional airflow is similar (most p>0.05) and predominantly surrounding the inferior turbinate. Strong postoxymetazoline to postsurgery correlations were observed in decreased nasal resistance (r=0.79, p<0.05), increased regional airflow rates (r=-0.47 to -0.55, p<0.05) and regional air/mucosa shear force and heat flux (r=0.43 to 0.58, p<0.05); however, only increasing peak heat flux significantly correlated to symptom score improvement (NOSE: r=0.48, p<0.05). We present the first objective evidence that the "topical decongestant test" can help predict turbinate reduction surgery outcomes. The predictive effect is driven by similar improvementin regional airflow that leading to improved air/mucosa stimulations (peak heat flux) rather than through reduced nasal resistance.

Sinus Irrigation with N-Acetylcysteine after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Preliminary Report of a Single-Blind Randomized Controlled Trial.

Nasal irrigation is crucial following endoscopic sinus surgery (ESS), especially for managing chronic rhinosinusitis (CRS). This study assessed the effectiveness of N-acetylcysteine (NAC) irrigation during the post-ESS period of patients with CRS without nasal polyposis. In this prospective, single-blind randomized controlled trial, 49 patients (NAC, n = 24; saline, n = 25) undergoing ESS were assigned to receive either NAC or saline irrigations twice daily for a month. The preoperative and postoperative assessments conducted included Lund-Macka (LM) and Lund-Kennedy (LK) endoscopic scores, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Sino-Nasal Outcome Test-20 (SNOT-20). At 2 weeks, 1 month, and 3 months after the operation, endoscopic findings and symptoms were evaluated. Both groups showed no differences in age, sex, LM and LK scores, NOSE scale, and SNOT-20 preoperatively. In terms of the endoscopic findings regarding the sinonasal mucosa after ESS, the NAC group had slightly lower scores 2 weeks, 1 month, and 3 months after the operation, but this difference was not statistically significant. The NAC group showed significant improvement in VAS scores, namely, postnasal drip (1.0, p = 0.041), smell dysfunction (0.8, p = 0.003), and crust (1.5, p = 0.034), compared to the control group's scores of 2.6, 4.7, and 3.6, respectively, 2 weeks after the operation, although no significant differences were observed in VAS scores for any symptoms 1 and 3 months after the operation. NAC was well tolerated, and no adverse events were reported. NAC irrigation showed benefits over saline irrigation in terms of improving postnasal drip, smell dysfunction, and crust after ESS for CRS without nasal polyposis in the immediate postoperative period.

Feasibility of Dorsal Preservation Rhinoplasty for Hump Nose Reduction in Asian Population.

Background: Dorsal preservation rhinoplasty (DPR) has shown promise in Western populations for nasal hump reduction, but its feasibility and long-term outcomes in Asian individuals remain unexplored. Objective: To measure the feasibility, as well as the functional and aesthetic outcomes, of DPR in Asian hump noses and to determine its effectiveness in adaptation to the unique characteristics of the Asian demographic. Methods: A retrospective review analyzed patients who underwent primary DPR between April 2019 and November 2022 with a follow-up period of over 12 months. The study included patients whose photographs met the criteria. Surgical techniques, aesthetic measurements using anthropometric factors, and subjective outcomes were evaluated. Results: Of the 17 patients (11/17, 64.7% female), the mean age was 22.53 years (standard deviation [SD] 5.22 years). The median follow-up period was 36.90 months (range 13-61 months). Measurements from pre- and postoperative photographs showed a significant reduction in both nasofacial angle (7.76°, SD 4.30°) and rhinion angle (0.85°, SD 0.69°) (p < 0.0001). Patient-reported outcome scores with the Nasal Obstruction Symptom Evaluation scale decreased from 61.00 (SD 26.96) to 15.50 (SD 11.65), and Standardized Cosmesis and Health Nasal Outcomes Survey scores postoperatively were 10.90 (SD 7.71) overall, with the functional component at 3.50 (SD 2.64) and the aesthetic component at 7.40 (SD 6.24). No residual hump, recurrence of the hump, or complications were observed. Conclusion: In this study, the use of DPR techniques was effective and may support further development of the inclusion and exclusion criteria for its use in correcting the dorsal hump in Asian patients. Careful patient selection will be imperative to determine the ultimate indications for this technique.

Office-based blue laser therapy for inferior turbinate hypertrophy: a pilot study.

To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction. Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient's level of comfort during the procedure was also rated using a 10-point VAS scale. A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34. Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient's perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.

The benefit and clinical value of CT scan as preoperative assessment for structural functional septorhinoplasty

&lt;b&gt;Introduction:&lt;/b&gt; Structural functional septorhinolplasty is an operation designed to achieve both aesthetic and functionalgoals, which were the most important success parameters for patient satisfaction. Different preoperative examination toolsare available for assessment.&lt;b&gt;Aim:&lt;/b&gt; To evaluate the diagnostic benefit and clinical value of a CT scan, and compare it with other examination tools, such as nasal endoscopy and anterior rhinoscopy for structural functional septorhinoplasty&lt;b&gt;Material and Methods:&lt;/b&gt; A prospective randomized controlled study of 148 consecutive patients seeking for a solution to their primary problem of nasal obstruction, and also for a cosmetic effect within the same operation (structural functional septorhinoplaty). They were divided into 3 groups; CT scan group, endoscopic group, and control group (anterior rhinoscopy). The subjective postoperative assessment was carried out with the Nasal Obstruction Symptom Evaluation scale (NOSE), Rhinoplasty Outcome Evaluation scale (ROE), Visual Analogue Scale (VAS), and SNOT-22 score. Those outcomes at 12-month follow-up were compared to preoperative values.&lt;b&gt;Results:&lt;/b&gt; Among 148 patients, there were 77 males (52.02%) and 71 females (47.97%), age range between 19 to 52 years (mean age 23.4 2.7 SD). In all 3 groups, there was a significant clinical improvement in nasal symptoms and structural functional septorhinoplasty outcomes, as well as better ROE, NOSE, VAS, and SNOT-22 scores in the CT scan group when compared to the other two groups, with the P-values being 0.01, 0.01, 0.03, and 0.04, respectively.&lt;b&gt;Conclusions:&lt;/b&gt;CT scan is of greater benefit than nasal endoscopy and anterior rhinoscopy and constitutes the method of choice as a part of preoperative assessment in detecting any nasal pathology and assessing nasal anatomical structures prior to structural functional septorhinoplasty.

Olfactory Function and Surgery of the Lateral Nasal Wall - Systematic Review.

This study aimed to comprehend the influence of surgery on the lateral nasal wall, primarily focusing on the inferior turbinates, and its impact on olfactory function. A systematic review was carried out utilizing electronic databases like PubMed, Cochrane (including various registers and databases), and Web of Science. No restrictions were imposed on publication year or language. The PRISMA criteria guided study selection, and predefined inclusion and exclusion criteria were employed. Risk of bias assessment for randomized controlled trials (RCTs) utilized the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)," while Hawker et al. scale evaluated the quality of non-RCT studies. The review encompassed nine studies after rigorous selection and bias assessment. All studies unanimously demonstrated improved olfactory function following surgery on the inferior turbinate. Different surgical techniques and olfactory assessment methods were employed across studies. Evaluation encompassed pre- and post-surgery olfactory measurements. Most studies employed the Visual Analogue Scale (VAS) and commercial smell test kits (like Sniffin' Stick Test). The Nasal Obstruction Symptom Evaluation (NOSE) scale was used in two studies, and the butanol threshold test in one. Olfactory improvement was measured through enhanced patient numbers or nasal cavities, often expressed via VAS scores. One study utilized both patient count and VAS scores. A few studies also employed NOSE scale and olfactory threshold measurements. All studies consistently concluded that olfactory function post-surgery was superior to preoperative measures. The collective evidence strongly suggests that surgery on inferior turbinates has a positive impact on olfactory function, as indicated by the studies reviewed. Nonetheless, for a comprehensive understanding of surgical efficacy, future research should incorporate randomized controlled trials featuring control groups. This would facilitate the establishment of optimal surgical techniques for specific indications and the formulation of practical guidelines.

Reliability and Validity of the Persian Nose Obstruction Symptom Evaluation (NOSE) Scale.

The nasal obstruction symptom evaluation (NOSE) scale is a valid and specific questionnaire for evaluating nasal obstruction. The present study aimed to assess the validity of the Persian version of the NOSE questionnaire. The present study is a cross-sectional study conducted from December 2018 to April 2019. In the study group, eligible individuals referred to one clinic and Firoozgar Hospital, Tehran, Iran (a tertiary referral center) were asked to complete the questionnaire once on the first visit and once 3 months after the surgery. In the control group, healthy adults (above 18 years old) were selected among staff, students, residents, or relatives of the project executors. The NOSE questionnaire has 5 questions and a quality chart. The results were compared with the short form of the 12-item GHQ-12 questionnaire that had previously been translated and validated. SPSS 20 software was used to calculate Cronbach's alpha and intra-class correlation coefficient and to examine the convergent and discriminative validities. The results obtained are consistent with the results of the primary research when developing the questionnaire and the results of studies conducted with different versions of the questionnaire in different languages and cultures. Analysis of research data showed that the Persian version of the NOSE questionnaire has acceptable internal consistency, repeatability, convergent validity, and discriminant validity. The Persian version of the NOSE questionnaire has good validity and reliability.

Evaluating post-rhinoplasty nasal obstruction treatment: The efficacy of VivAer radiofrequency ablation

PurposeNasal obstruction is a prevalent issue affecting up to one-third of adults, often requiring surgical intervention. Low-temperature radiofrequency (RF) treatment, specifically VivAer, has emerged as a promising alternative, especially for the treatment of nasal valve collapse (NVC). However, its efficacy in patients with a history of rhinoplasty or nasal valve repair remains unexplored. MethodsA single-center retrospective chart review was conducted on 37 patients with a history of rhinoplasty or nasal valve repair who underwent VivAer RF treatment. Treatment outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale. The primary outcome was defined as a decrease in NOSE score by at least one severity category or a 20 % reduction in total NOSE score. ResultsThe study found a statistically significant average reduction in NOSE score of 22.4 points or 36.6 %. Among patients with a positive treatment response (21 patients or 56.8 %), the average NOSE score reduction was 34.7 points or 55.6 %. Repeat RF treatment in non-responders resulted in a 50 % response rate. No significant difference was observed in treatment outcomes based on the type of prior rhinoplasty or NVC. ConclusionsTemperature-controlled RF treatment with VivAer can effectively alleviate nasal obstruction in patients with a history of rhinoplasty or nasal valve repair, offering a viable alternative to revision surgery. The study also highlights the potential benefit of repeat RF treatment in non-responders. Further research, including randomized controlled trials, is needed to validate these promising results and expand the treatment options for this complex patient population.

Surgical Management of Airway Obstruction Following Posterior Pharyngeal Flap.

Posterior pharyngeal flap (PPF) is effective in managing velopharyngeal insufficiency (VPI) but is of airway obstruction risk. This study compared the effectiveness and complications of two PPF revision procedures and screened potential prognostic factors to postoperative hypernasality and persistent obstruction. Patients who received flap division (FD) or port enlargement (PE) for airway obstruction following PPF were reviewed. Ventilation status was assessed using the nasal obstruction symptom evaluation (NOSE) scale, and velopharyngeal closure was assessed using subjective speech evaluation and nasopharyngoscopy. The effectiveness of ventilation relief and complication rate (hypernasality and persistent obstruction) of the two techniques were compared. A comprehensive panel of factors, including age, velopharyngeal mobility, obstruction laterality, body mass index, jaw relationship, and adenoid hypertrophy, were evaluated for correlation with complications. 79 patients were enrolled, with 51 receiving FD and 28 PE. Both techniques significantly improved ventilation dysfunction and hyponasality. Mild hypernasality occurred among 10 cases in the FD group and 3 in the PE group. Age at surgery was significantly associated with persistent obstruction after PPF revision. The occurrence of persistent obstruction was significantly higher among patients below 12 years than those above. Obstruction laterality was suggested in significant correlation with hypernasality post-PPF revision. Among patients with unilateral port obstruction, the occurrence of hypernasality after FD was significantly higher than after PE. Both flap division and port enlargement are effective revision procedures to relieve airway obstruction after PPF. Patients below 12 years are more likely to experience persistent ventilation problem after PPF revision.

Functional and esthetic outcomes of functional rhinoplasty for internal nasal valve dysfunction in Asian patients

ObjectiveThis study aimed to use validated measures to evaluate the functional and esthetic outcomes in patients who underwent functional rhinoplasty for Internal Nasal Valve Dysfunction (INVD) in Korea. MethodsA retrospective review of consecutive patients who underwent functional rhinoplasty for INVD confirmed by endoscopic findings and the modified Cottle test between 2016 and 2018 was performed. Nasal obstruction was assessed with the Visual Analog Scale (VAS) and nasal obstruction symptom evaluation (NOSE) scale. Acoustic rhinometry was performed pre- and post-operatively. The Minimal Cross-Sectional Area (MCA) of the nose was measured. Objective assessment of the esthetic outcomes was performed with the Objective Rhinoplasty Outcome Score (OROS), which assesses tip rotation, projection, width, dorsal height, width, length, symmetry, and the overall result. ResultsFifty-seven patients (46 men and 11 women; mean age, 30.5 ± 12.3 years) who underwent functional rhinoplasty were included in this study. The VAS and NOSE scores indicated functional improvement in all cases (all p < 0.001). There were no significant between-group differences (VAS score, p = 0.274; NOSE score, p = 0.952). The objective functional outcomes evaluated using MCA on the concave (p = 0.478) and convex (p = 0.631) sides did not differ significantly pre- and post-operatively. The subjective evaluation of esthetic satisfaction revealed no between-group difference. Moreover, 31 out of 44 patients (70.5%) with static INVD and nine out of 14 patients (64.3%) with dynamic or combined INVD showed excellent outcomes. Regarding objective esthetic outcomes, scores for the eight factors were >3, and there was no significant difference between the two groups (all p > 0.05). ConclusionsFunctional rhinoplasty, including extracorporeal septoplasty and spreader grafting, may be a viable option for correcting INVD with functional and esthetic improvement. Dynamic INVD is less prevalent among Asians, and there was no significant difference in the surgical outcomes compared with those of static INVD. Level of EvidenceLevel 4.

The Rhinoplasty Rosetta Stone: Using Rasch Analysis to Create and Validate Crosswalks between the NOSE and the SCHNOS Functional Subscale.

The Nasal Obstruction Symptom Evaluation (NOSE) and the Functional subscale of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) are widely used patient-reported outcome measures to measure functional outcomes of rhinoplasty. However, as different instruments produce scores on different metrics, results of these instruments cannot be linked directly, thus hindering comparison and aggregating of rhinoplasty outcome data from practices using either instrument. The aim of this study was to develop and validate crosswalks between the NOSE and the SCHNOS-O. In a sample of 552 rhinoplasty patients who completed both instruments, the NOSE and SCHNOS-O scales were co-calibrated onto a common interval-scaled metric using Rasch analysis. Separate Rasch models were run per instrument, and the latent constructs were estimated using the calibrated item parameters. By anchoring original patient-reported outcome measure scores of both instruments to this Rasch computed measurement scale, the scores of both instruments were linked. A second independent sample was used to validate the created crosswalks. Total scores on the NOSE and SCHNOS-O were strongly correlated. The Rasch-based co-calibration of the NOSE and SCHNOS-O items resulted in a model that adequately fitted the data. Back-and-forth crosswalk tables were created from the NOSE to the SCHNOS-O. For patients with moderate nasal obstruction, predicted SCHNOS-O scores were slightly higher for a given level of the NOSE. Intraclass correlation coefficients between predicted and actual scores were 0.93 for both directions, indicating adequate agreement for group-level comparisons. This study developed and validated Rasch-based crosswalks from the NOSE to the SCHNOS-O and vice versa. The provided crosswalks enhance comparison and harmonization of functional rhinoplasty outcomes.

The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction.

Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.