Nasal Obstruction Symptom Research Articles

Assessment of Nasal Breathing Function and Tip Definition after the Implementation of the Cephalic Lateral Crural Advancement Flap Technique.

Cephalic trimming of the lower lateral cartilage (LLC) can result in the collapse of the internal and external nasal valves, pinched nose, and alar retraction. The cephalic lateral crural advancement flap (CLCAF) technique is introduced as a method to prevent these complications by avoiding grafts in the LLC. A retrospective study was conducted on 126 open-approach rhinoplasties (82 female and 44 male) employing the CLCAF technique between January 2021 and March 2022. Preoperatively, 20 patients exhibited collapse of the internal nasal valve. CLCAF was performed in all patients following cephalic incision, leaving 7 to 8 mm horizontally and caudally of LLC, and preserving the scroll ligament. The CLCAF was advanced onto the lateral crura to reinforce it and tension the scroll ligament. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to assess the technique. The average postoperative follow-up period was 14 months. Overall, 114 patients (90.5%) experienced improved nasal breathing on the NOSE scale, and the overall NOSE score significantly decreased from a mean of 30.4 to 14.0 (p < 0.001). A statistically significant reduction in NOSE scores was observed in groups with moderate, severe, and extreme obstruction (p < 0.001), with greater improvement seen in the patients with more severe preoperative nasal breathing obstruction. Postintervention, no patient exhibited collapse of the internal valve, and all patients with preoperative collapse of the internal nasal valve showed an increase of at least 40 points in the NOSE scale. Two patients required revision due to tip asymmetry related to CLCAF. Pinched nose or alar retraction was not observed postoperatively in any patient. The implementation of CLCAF, combined with other techniques, enhances nasal breathing function, prevents the collapse of the internal nasal valve, and leads to optimal nasal tip definition, resulting in a better-shaped and functioning nose.

Quality Of Life In Post Septorhinoplasty Our Experience

Background: The demand for Septorhinoplasty has significantly increased over past two decades due to increased personal interest, media awareness and advances in surgical techniques. This trend is most common in younger age group for both men and women. The quality of surgery, surgeon’s level of expertise and most importantly the patient’s level of expectation are important factors in patient satisfaction with Septorhinoplasty. Materials and Methods: After approval from ethics committee, a prospective observational study was taken at our tertiary care Centre for a period of 18 months in 32 patients of age group between 18 years to 50 years both males and females both literates and illiterates. NOSE (Nasal Obstruction Symptom Evaluation) questionnaire, which scores nasal function and ROE (Rhinoplasty Outcome Evaluation) questionnaire, which scores cosmetic status is used to measure the outcome evaluation questionnaire undertaken 1 day prior to surgery, 3 months and 6 months post-surgery and outcome noted Results: The mean pre and post operative nose score were 72.50± (15.34) and 19.06 ±(11.03) respectively. Post op NOSE score was significantly lower than pre op score (p&lt;0.0001). Post op ROE score 75.10± (10.66) were significantly higher than pre op score 28.10± (8.2) (p&lt;0.0001). Conclusion: The present study showed that in our patient population both form and function are overwhelming improved with septorhinoplasty

Exposition of an unusual presentation: a case report of benign tumor arising from an uncommon origin

The inverted papilloma is a benign neoplasm that originates from the sinonasal mucosa, which is also referred to as a Ringertz tumor. It mostly affects men, falling within the age groups of 50 to 60 years. Our case is rare of its type as it was present in an unusual site, which is from the middle turbinate. Here in our study, we report a case of a 25-year-old female presented to the ENT outpatient department with complaints of left-sided nasal obstruction for 4 years. The patient had noticed a pinkish mass in the left nasal cavity. She complained of intermittent episodes of left-sided nasal bleeds. The patient was planned for functional endoscopic sinus surgery with a partial middle turbinectomy under general anaesthesia. Histopathological examination showed polypoidal tissue fragments lined predominantly by non-keratinized stratified squamous epithelium, along with focal areas lined by respiratory-type pseudostratified columnar epithelium and transitional epithelium, with multiple foci of inward proliferation of the epithelium in the form of nests into the underlying sub epithelium with an intact basement membrane, which is suggestive of inverted papilloma. After one week of postoperative follow-up, patient’s symptoms of nasal obstruction were relieved. During the subsequent 6 months of follow-up, the patient had no evidence of tumor recurrence. In our case, we wanted to emphasize that not all cases that do not involve the maxillary sinus or the medial wall of the maxilla on a CT scan require medial maxillectomy.

The benefits of septoplasty for patients with deviated nasal septum and allergic rhinitis: a meta-analysis

BackgroundThe value of endoscopic septoplasty for patients with deviated nasal septum and allergic rhinitis has not been systematically summarized. This study aims to assess the impact of surgical intervention on quality of life through a meta-analysis.MethodsWe conducted a comprehensive search of PubMed, CNKI, EMBASE, and the Cochrane Library for studies on the treatment of patients with deviated nasal septum and allergic rhinitis up to 2024. Studies that were duplicates, lacked full text, had incomplete data, or involved animal experiments, commentaries, or systematic reviews were excluded. Meta-analysis was performed using STATA 16.0.ResultsThe total nasal symptom score (TNSS) in patients who received endoscopic surgery was considerably reduced compared to those treated with spray therapy alone, indicating a significant improvement (SMD = -21.29, 95% CI: -26.26, -116.33). Classic symptoms of allergic rhinitis, including rhinorrhea (SMD=-9.97, 95% CI: -16.97, -2.98), nasal obstruction (SMD=-27.25, 95% CI: -41.12, -13.38), nasal itching (SMD=-10.32, 95% CI: -13.16, -7.48), and sneezing (SMD=-12.66, 95% CI: -14.99, -10.34), showed significant improvement. There was no significant difference in the incidence of complications between the two treatments (OR = 1.01, 95% CI: 0.49, 2.10).ConclusionPatients with a deviated nasal septum and allergic rhinitis benefit more from septoplasty. However, the procedure should be performed cautiously by experienced clinicians, taking into account the specific condition of the nasal septum.

Self-Induced Nasal Septal Perforation: Rhinotillexomania-A Different Entity From Nose Picking.

Nose picking is a common habit that rarely leads to mutilating self-injury. It is important to distinguish between rhinotillexomania (compulsive nose picking) as a disease and nose picking that results in or contributes to nasal septal perforation (NSP). The aim of this study is to investigate the impact of rhinotillexomania and NSP repair on sinonasal symptoms and quality of life (QoL). Patients with symptomatic NSP due to rhinotillexomania and candidates for surgical repair were included. Sinonasal symptoms and QoL were measured using a visual analogue scale (VAS), Sinus CT scan, Barcelona Smell Test 24 (BAST-24), Sinonasal outcome test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), NOSE-Perf, and Medical Outcome Study Short Form (SF-36). Healthy volunteers without sinonasal disorders (n = 43) were also included. A total of 37 patients with Rhinotillexomania (20 male [54.1%]; mean age, 49.2 years [SD 15.4]) were recruited. Totally 32 patients (86.5%) had NSP with the posterior border anterior to the incisive canal. Follow-up data were registered for 29 patients with a mean follow-up duration of 22.1 months (standard deviation, SD 16.7). The overall success rate of NSP repair was 96.6%. Patients experienced significant improvement in sinonasal symptoms and QoL after surgery. Rhinotillexomania is a distinct entity from nose picking. Multidisciplinary approach including behavior therapy and NSP repair are considered the best approaches to relieve sinonasal symptoms. Placing nasal silicone sheets is recommended when the diagnosis of rhinotillexomania is confirmed. The greater palatine artery flap combined with inverted edges appears to be the most effective approach. Level 3 Laryngoscope, 2024.

What is the impact of biological treatment on sleep quality in chronic rhinosinusitis with nasal polyps patients: a retrospective cross-sectional study

BackgroundSleep disturbance is prevalent in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Although biological treatment has been shown to improve overall patient-reported sinonasal symptoms in CRSwNP, the treatment impact on individual sleep quality remains less explored. The purpose of this study is to investigate the effect of dupilumab treatment on sleep quality in patients with CRSwNP.MethodsA single-institutional, retrospective chart review was conducted on adult patients who received biological treatment (dupilumab) for CRSwNP. Patients’ condition was assessed before treatment and 3–12 months after continuous treatment. The assessment included the 22-item Sino-Nasal Outcome Test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) scale, Nasal Polyp Score (NPS), as well as perception for anosmia and hyposmia using Visual Analog Scale (VAS) for smell. Sleep-related symptoms and treatment outcomes were assessed using the Pittsburg sleep quality index (PSQI) global score, sleep domain questions within SNOT-22, and sleep-related question in the NOSE scale. Subjects with a PSQI global score of > 5 were considered poor sleepers.ResultsA total of 15 charts were included in this study. There were 12 males (80%) and 3 females (20%). Sixty percent of them were having bronchial asthma. The mean follow-up duration was around 6.7 months. The patients showed significant improvement in nasal assessment using the median values for SNOT-22, NOSE scale, NPS, and VAS for smell (P-value ≤ 0.001). As well, there was a significant improvement in the median scores for global PSQI, sleep domain questions within SNOT-22, and sleep-related question in the NOSE scale (P-value 0.04, < 0.001, and 0.001, respectively). Eight subjects (53.3%) had poor sleep quality before treatment. Four out of them improved from being poor sleepers to good sleepers after using the treatment.ConclusionThis study indicates that dupilumab is an effective treatment for CRSwNP and it improves sleep quality parameters in some patients.

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.

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.

Designing a Nasal Lining-Framework Complex for Reconstructing Total Nasal Defects.

To validate the feasibility of an innovative nasal lining-framework complex (NLFC) for reconstructing total nasal defects. Retrospective cohort study. This NLFC is composed of forearm flap and support framework. Twenty-four patients were followed up for a minimum of 17 months in 5 centers. Patients' medical history data were retrospectively analyzed. Visual Analog Scale (VAS) of surgeons and patients was used to evaluate the aesthetic effects and self-satisfaction. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and Rhinoplasty Outcome Evaluation (ROE) questionnaire were used for functional assessment. Reconstruction surgeries were all successfully completed. The flaps healed well in all patients, and there were no signs of ischemic necrosis. The healing time of the wound was 10 to 14 days, except for 1 case with infection. The nasal lining was reconstructed and no significant contracture was observed. The average VAS of surgeons was 4.29 ± 0.69 (range 3-5). The mean VAS score of patients was 3.75 ± 0.79 (range 2-5). There was a significant positive correlation between patients' and surgeons' VAS scores (P = .007, r = .5355). The results of the NOSE questionnaire showed that all patients had no obvious ventilation restriction, and only 3 patients mildly felt that the nasal inspirations were slightly insufficient during exercise or exertion. The mean ROE of the patients was 21 ± 1.96 (range 18-25). This NLFC is suitable for total nasal reconstruction, which can provide effective support to prevent flap collapse and retraction and ensure good nasal ventilation. Level IV, therapeutic study.

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.

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.

Association between empty nose syndrome and laryngopharyngeal reflux disease: a preliminary cohort study.

To investigate the association between laryngopharyngeal reflux disease (LPRD) and Empty Nose Syndrome (ENS). Nasal and laryngopharyngeal reflux symptoms were investigated in patients with ENS. Symptoms were evaluated with reflux symptom score-12 (RSS-12), nasal obstruction symptom evaluation (NOSE), empty nose syndrome 6-item questionnaire (ENS6Q), empty nose syndrome index (ENSI), and sinonasal outcome tool-22 (SNOT-22). The anxiety and depression were assessed with the general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). A study of association was conducted between demographics and patient-reported outcome questionnaires. Forty-one ENS patients were included (20 females (48.8%)). The control groups included 27 patients with rhinitis/rhinosinusitis and 36 asymptomatic individuals. The ENSI and ENS6Q detected ENS in 97.6% and 90.2% of cases, respectively. The mean scores of ENSI, ENS6Q, RSS-12, NOSE, and SNOT-22 were significantly higher in the ENS group compared to controls. The prevalence of suspected LPRD was 90.2% in the ENS group, which was significantly higher compared to controls. The prevalence of mild, moderate, moderately severe, and severe depression in ENS patients was 7.3% (n = 3), 4.9% (n = 2), 39.0% (n = 16), and 46.3% (n = 19), respectively. RSS-12 reported significant and high associations with the ENS6Q (rs=0.939; p = .001) and ENSI (rs=0.699; p = .001). LPRD symptoms and prevalence were significantly higher in ENS patients compared to controls. Future controlled studies are needed to investigate the prevalence of LPRD in ENS patients through objective approaches (impedance-pH monitoring, nasal digestive enzyme measurements).

Outcomes after Functional Nasal Surgery in Patients with Versus without Rhinitis Medicamentosa.

Topical nasal decongestants (TNDs) are used to reduce nasal soft tissue edema and obstruction. However, after frequent TND use, patients can develop rhinitis medicamentosa (RM) with rebound nasal edema and obstruction. Management of RM has centered largely on TND cessation ± intranasal corticosteroids. The purpose of this study was to compare nasal obstruction outcomes following nasal obstruction surgery in patients with versus without RM. A retrospective case-control study was conducted with adult patients who underwent bilateral inferior turbinate reduction (ITR) with or without septoplasty and nasal valve repair. Patients with versus without RM were assessed. RM was defined as at least daily TND use for ≥4 weeks. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores, and long-term TND cessation rates were collected. NOSE score changes were compared between patients with versus without RM. Of the 36 RM patients, mean age was 52.0 years, and 63.9% were male. Of 116 non-RM patients, mean age was 41.6 years, and 46.6% were male. Postoperative NOSE scores were collected at a mean 972.1 days postoperatively for RM patients, and 565.0 days for non-RM patients. Mean NOSE score reductions were - 9.8 for RM and - 8.6 for non-RM patients, both of which were significant (p < 0.0001). NOSE score reductions were not significantlybetween the two groups (p = 0.2438). Long-term TND cessation was maintained in 86.1% of RM patients. Patients with and without RM achieved similar long-term significant NOSE score reductions following nasal obstruction surgery, and 86.1% of RM patients maintained long-term TND cessation. Level 3 evidence Laryngoscope, 2024.

Screening of Sensorial and Inflammatory Changes in Patients Submitted to Orthognathic Surgery.

Despite the high levels of success after orthognathic surgery, the immediate postoperative pain and edema, besides the neurosensorial deficits, are common complications. This study aimed to evaluate the pattern of sensory and inflammatory responses in patients undergoing orthognathic surgery. This prospective observational study included 20 patients undergoing bimaxillary orthognathic surgery, who were evaluated in the preoperative period and on Days 1, 2, 3, 4, 5, 6, 7, and 30 after surgery, using a battery of tests to assess sensorial and inflammatory changes. Subjective and objective evaluations of edema indicated a trend toward edema resolution within 30 days, with a significant decrease in mouth opening on days 1, 7, and 30 after surgery. Regarding nasal obstruction, a significant increase in Nasal Obstruction Symptom Evaluation (NOSE) scores was demonstrated on the first, second, and third days, returning to preoperative levels after 30 days. There was a significant increase in visual analogic scale (VAS) scores from the first to the seventh day after surgery, with a reduction within 30 days. For mechanical and thermal sensitivity tests, the lower lip and chin regions had poorer results, without recovery after 30 days. Positive correlations were observed between painful and inflammatory parameters, as well as between subjective and objective evaluations. Analysis of saliva biomarkers did not show significant differences for pre- and postoperative CCL3 or CCL4 levels. Data provide new evidence about the early inflammatory and sensorial complications after orthognathic surgery.

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.

The Prevalence of Migraine among Patients with Nasal Obstruction

Abstract Background: Nasal obstruction is a common health issue that often coexists with headaches, particularly migraines, impacting the quality of life and overall health of affected individuals. The association between nasal obstruction and migraine has been suggested in previous studies, emphasizing the need for further investigation. Objectives: This study aimed to evaluate the prevalence, pattern, and risk factors for migraine headaches among individuals with nasal obstruction and to assess the impact of nasal obstruction on migraine frequency and severity. Methods: A cross-sectional survey was conducted in Taif City, Saudi Arabia, to compare the proportion of patients with nasal obstruction who reported having migraine headaches to that of patients who did not. This research was performed on adult participants with nasal obstruction symptoms from May 2023 to July 2023. Data were collected through an online questionnaire that assessed sociodemographic characteristics, nasal obstruction symptoms using the nasal obstruction symptom evaluation Scale, and migraine history using the migraine screen questionnaire. The data were analyzed using IBM SPSS version 22. Results: Among a total of 572 participants with nasal obstruction included in the study, 40.7% experienced migraine, and 64.5% reported headaches lasting longer than 4 h. There were significant associations between migraines and troublesome nasal breathing, sleep disturbances, and difficulty breathing through the nose during exercise or exertion. Conclusions: The study findings support the link between nasal obstruction and migraines, with a high incidence of migraines among individuals with nasal obstruction. This study provides valuable insights into the prevalence and impact of migraines among patients with nasal obstruction. These findings underscore the need for improved diagnosis, management, and quality of life for individuals affected by nasal obstruction and migraines.

Twelve-month outcomes following temperature-controlled radiofrequency treatment of the septal swell body for nasal airway obstruction.

Improved nasal airway obstruction (NAO) symptoms were reported at 3 months following temperature-controlled radiofrequency (TCRF) treatment of the septal swell body (SSB). This report provides results from assessments of the long-term safety and efficacy of TCRF treatment of SSB hypertrophy to treat NAO through 12 months posttreatment. This prospective, multicenter, long-term, open-label study was conducted in nine centers within the United States and included patients with severe/extreme NAO attributed to SSB hypertrophy. Outcome measures included assessments of Nasal Obstruction Symptom Evaluation Score (NOSE), Numeric Rating Scale (NRS) ease-of-breathing, patient satisfaction, and adverse events at 6 and 12 months. Of the 70 patients treated, 65 and 62 patients completed the 6- and 12-month follow-up assessments. Compared to baseline, there was a 67.5% decrease in adjusted mean NOSE scores at 6 months (mean change -49.6, 95% confidence interval [CI] -54.8 to -44.4; p<0.001) and a 65.4% decrease at 12 months (mean change -48.1, 95% CI -53.7 to -42.5); p<0.001), which is consistent with previously published 3-month results. A 62.0% and 62.5% improvement compared to baseline was observed in the NRS ease-of-breathing score at 6 and 12 months, respectively (p<0.001). No serious adverse were reported overall and no new device- or procedure-related adverse events were reported in the interval between 3 and 12 months posttreatment. TCRF treatment of SSB hypertrophy has a significant and durable effect on improving the symptoms of NAO and health-related quality of life in patients with symptoms of nasal obstruction and congestion through 12 months postprocedure.

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.

Sinonasal Complications of Combined Transseptal–Transnasal and Bilateral Transnasal Approaches for Endoscopic Endonasal Transsphenoidal Pituitary Surgery

BackgroundThe endoscopic combined transseptal–transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. MethodsUtilizing a retrospective cohort from a preeminent tertiary referral center, we analyzed 141 cases of endoscopic endonasal transsphenoidal surgery performed between March 2018 and May 2023. Outcomes for the transseptal–transnasal group (n = 71) and the conventional bilateral transnasal group (n = 70) were compared. Nasal endoscopy and computed tomography were used to assess anterior nasal septal perforation. Functional outcomes were assessed preoperatively and at 6 months postoperatively using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and nasal obstruction symptom evaluation (NOSE) ResultsThe transseptal–transnasal approach exhibited reduced rates of postoperative ear fullness (p < 0.001), along with fewer subjective complaints of smell/taste loss (p = 0.022) and thick nasal discharge (p = 0.008), compared to the conventional approach. However, objective smell test results were not significantly different between the two approaches (p = 0.243 and p = 0.454 for CCCRC and CCSIT, respectively). Additionally, although statistically insignificant, a higher incidence of anterior septal perforation was observed with the transseptal–transnasal approach (p = 0.067). ConclusionFor the surgical treatment of pituitary adenomas, the transseptal–transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.

Optimizing Corticosteroid Sinonasal Irrigation Outcomes Through 3D Printing: A Randomized Pilot Clinical Trial.

Topical corticosteroid irrigation plays critical role in the management of chronic rhinosinusitis (CRS). Yet, its efficacy can be highly variable. We sought to determine if personalized, 3-dimensional (3D)-printed nasal models can optimize head positioning and irrigation parameters, therefore improving patient outcomes. Randomized, single-blinded clinical trial. Tertiary medical center from November 2021 to July 2023. Sixty-two patients with CRS were randomized into either control (CG), backfill (BG), or model (MG) groups; daily 2 mg mometasone irrigations were then performed for 2 months with either standard head-forward and natural side-tilt position (CG), a head tilt of 90° to the side with fluid entering the lower nostril (BG), or in an optimized position as determined by a patient-specific 3D printed irrigation model (MG), respectively. A total of 36 patients completed the trial (CG: N = 14/23; BG N = 11/23, MG: N = 11/16). Significant posttreatment improvement in Lund-Mackay (LM) scoring was only observed in the MG (-3.73, 95% confidence interval = -5.71, -1.75; P < .001). Patient-reported outcome measures (Nasal Obstruction Symptom Evaluation, Sinonasal Outcome Test-22, and Visual Analog Scale of nasal congestion) improved significantly among all groups. Optimal model penetration scores significantly correlated to posttreatment MG LM score (Spearman's r = 0.65, P < .05). Among all groups, patients with prior endoscopic sinus surgery (ESS) (n = 19) had objectively less opacification at baseline; however, experienced the same degree of opacification reduction and symptom reduction as those without prior ESS (n = 17). The use of 3D printing to personalize head positioning may significantly improve objective corticosteroid irrigation outcomes. Mometasone irrigation may have similar subjective and objective effects on patients regardless of prior surgical history. Level 1 prospective, randomized, single-blinded clinical trial NCT06118554.