Symptom Scores For Nasal Obstruction Research Articles

A comparative study of the outcomes of endoscopic septoplasty with conventional septoplasty

Background Deviated nasal septum is common problem in otolaryngorhinological practice. This study was mainly undertaken to compare the advantages and disadvantages of endoscopic septoplasty over conventional septoplasty. Material and methods A prospective study was undertaken in 60 patients attending ENT OPD in a tertiary care centre. The sample was selected by using non-probability convenient sampling technique. Equal number of patients were randomly allocated in to endoscopy and conventional groups by double blinding method. Preoperative nasal obstruction symptom score was noted and intraoperative time was noted in minutes. Al the patients received pe medication and operated adhering to strict protocol. The patients were followed at weekly interval for complications and success rates. Results The mean age of the patients was 27 years and majority of the patients were males. Nasal blockage was the common symptom in the study group. The nasal airflow improved to 4 – 5 cm2 in patients of both the groups. The mean duration of the surgery was 60.37 minutes in endoscopic group and 54.07 minutes in conventional group. Unilateral mucosal tear was the common intraoperative complication and was seen more in conventional group than the endoscopic group.

Clinical Characteristics of Patients with Dental Malocclusion: An Otolaryngologic Perspective.

Purpose: Allergic rhinitis (AR), which is a major cause of upper airway obstruction, may affect the development of the dental malocclusion. This retrospective study was aimed to investigate association between AR and dental malocclusion in otolaryngologic perspectives. Methods: Patients (n = 217) referred to the otolaryngology department before initiating orthodontic treatment were recruited. The frequency and severity of AR symptoms, sinonasal outcome test (SNOT-22) scores, physical examination findings, acoustic rhinometry results, and treatment modalities were retrospectively assessed. Patients with positive skin prick test findings (SPT) (n = 173; orthodontic group) were compared with age- and sex-matched patients being treated for AR (AR group). Results: We found that 76.5% of the enrolled patients had subjective nasal symptoms, and 93.1% patients showed abnormal physical examination findings such as inferior turbinate hypertrophy (82.0%), adenotonsillar hypertrophy (31.8%), or deviated nasal septum (7.4%). The 173 (79.7%) patients with positive SPT results exhibited a significantly higher incidence of rhinorrhoea, sneezing, and inferior turbinate hypertrophy compared to those with negative SPT results. The proportion of patients who underwent pharmacological or surgical treatments was significantly higher among patients with nasal obstruction (92.0%) than among patients without nasal obstruction (36.9%). The frequency and mean visual analogue symptom scores for nasal obstruction, rhinorrhoea, and sneezing, as well as all SNOT-22 domain scores, were significantly higher in the AR group than in the orthodontic group. The minimal cross-sectional area measured with acoustic rhinometry showed no significant difference between groups. Conclusion: Patients with dental malocclusion had a high SPT (+) rate and a high prevalence of structural abnormalities of the upper airway. The early detection and treatment of subclinical AR, other rhinological problems, and structural abnormalities of the upper airway in patients with malocclusion may help us manage malocclusion from an otolaryngologic perspective.

Evaluation of Patient Satisfaction After Nasal Septoplasty Operation Using Peak Nasal Inspratuar Flow and Nasal Obstruction Symptom Score Questionare.

The purpose of this study was to investigate the usefulness of the peak nasal inflamatuar flow (PNIF) and Nasal Obstruction Symptom Score (NOSE) questionnaire in the diagnosis and follow-up of nasal septum deviation surgery. Sixty patients diagnosed with nasal septum deviation were included in the study. Nasal Obstruction Symptom Score scales of patients, PNIF and is measured preoperatively and 14 days after surgery. Preoperative NOSE scores were 14.9 ± 2.7 and PNIF scores were 129.6 ± 15.5 L/min in study group. Postoperatively NOSE scores were 7.9 ± 1.8 and PNIF scores were 154.2 ± 9.2 L/min in study group. Nasal Obstruction Symptom Score scores were 3.3 ± 2.3 and PNIF scores were 169.3 ± 13.5 L/min in control group. Anterior and anteroposteriorly located nasal septum deviation (NSD) had statistically higher degrees of NOSE scores and lower levels of PNIF scores. Posterior located NSD PNIF scores changed postoperatively but NOSE scores do not change statistically. There was a statistically significant correlation in Pearson correlation analysis between NOSE and PNIF scores. The authors recommend using PNIF and NOSE scores in NSD patients.

Unilateral Inner Mucoperichondrium Flap From Upper Lateral Cartilage and Inferior Mucosal Advancement Flap Technique for Repair of Septal Perforations.

Many surgical technique have been described for repair of nasal septal perforations with different success rates. This study aimed to describe authors' surgical technique and discuss its results as well as those reported in the literature. Nineteen patients with nasal septal perforation were operated on between March 2009 and February 2015 at Istanbul University, Istanbul Medical Faculty. The technique described in this article, closure of the perforation with unilateral upper lateral cartilage inner mucoperichondrial flap and inferior meatal advancement flap is an alternative surgical technique. Nineteen patients with symptomatic nasal septal perforation were operated with this technique. All surgical procedures were performed by the same surgeon. Neither intraoperative nor postoperative major complications were observed in any patients. Preoperative and postoperative symptom scores for nasal obstruction, epistaxis, nasal discharge, crusting, whistling, snoring, and olfactory loss as well as overall discomfort levels were compared using a visual analog scale. Complete closure of the perforation was achieved in 18 patients (95%). Small and large perforations may be reliably closed with this technique. Also, this technique can be easily applied via closed or external approach.

Improvement of Pulmonary Functions Following Septoplasty: How Are Lower Airways Affected?

ObjectivesNasal septal deviation is a frequent cause of increased nasal airway resistance. A narrow nasal airway would result in a decreased airflow into the lungs. The aim of the present study was to evaluate the alterations of the pulmonary functions following septoplasty using spirometry and 6 minutes walking test (6mWT). And reveal the correlation of symptom score improvement with nasal obstruction symptom score (NOSE) and sino-nasal outcome test (SNOT22) questionnaires following surgery.MethodsThirty patients with obvious nasal septal deviations were enrolled in the study. All patients had a detailed otorhinolaryngologic examination, filled NOSE/SNOT22 questionnaires, performed spirometry and 6mWT preoperatively. One month after surgery, NOSE/SNOT22 questionnaires filled by subjects and spirometry with 6mWT were performed again, and the results were compared.ResultsThe mean total walking distance was 702.3±68.2 m preoperatively, and it improved to 753.2±72.6 m postoperatively (P<0.001). Total tour count increased from 11 (range, 10.8 to 12.0) to 12 (range, 11 to 13.3), and the difference was found statistically significant (P<0.001). When the preoperative and postoperative mean 6mWT results were compared, diastolic blood pressure increased from 70 to 80 mmHg (P=0.031), heart rate increased from 83.5±13.2 to 90.1±12.5 bpm (P=0.017), dyspnea rate decreased from 1 to 0 (P=0.002), and fatigue scores reduced from 2 to 1 (P=0.003). Evaluation on spirometry findings revealed that FIF50% (maximum inspiratory flow at 50% of forced vital capacity [FVC]) scores and peak expiratory flow (PEF) values improved significantly after surgery. Septoplasty improves the nasal breathing pattern. While reducing FEF50% (maximum expiratory flow at 50% of FVC)/FIF50%, it increases PEF and FIF50% values. In addition, as shown by 6mWT, exercise capacity improves following surgery. Postoperative NOSE and SNOT22 scores reduced markedly compared to preoperative values (P<0.001).ConclusionThese findings suggest that nasal septal surgery has a positive effect on pulmonary functions, and this can be an important clue for the relationship of lung disorders and nasal obstruction.

Clinical Characteristics and Prognostic Factors in Pediatric Chronic Rhinosinusitis with Polyps

Background and ObjectivesZZChronic rhinosinusitis with nasal polyps is an uncommon pathology in the pediatric population and a challenging problem to otolaryngologists. In this study, we aimed to assess the clinical characteristics and postoperative results of children who underwent sinus surgery due to nasal polyps. Subjects and MethodZZWe retrospectively reviewed medical records of 45 pediatric patients who had sinus surgery from 2009 to 2012. We studied the relationship between clinical parameters and postoperative results. ResultsZZForty-five patients (18 women and 27 men with an age range of 8 to 17 years) were treated surgically in our hospital. We found statistically significant correlation between the pre operative CT scores (p=0.043), the nasal obstruction symptom scores (p=0.032) and postoperative recurrence, but not between other parameters. ConclusionZZIn this study, prognostic factors affecting the postoperative outcome were preoperative CT score and nasal obstruction symptom score. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:632-6 Key WordsZZEndoscopy ㆍNasal polyps ㆍPediatrics ㆍPrognosis ㆍSinusitis.

The Effect of Combined Medical Treatment on Quality of Life in Persistent Allergic Rhinitis

Allergic rhinitis may significantly affect the patients' quality of life. The aim of this study was to compare the effects of nasal steroids alone, to nasal steroids plus Levocetirizine or Montelukast, on quality of life in persistent allergic rhinitis. This is a prospective, randomized study and included 56 patients with moderate to severe persistent allergic rhinitis. All patients had house dust mite allergy on skin prick test and we divided the patients into three groups. 1month long medical treatment was; topical Mometasone furoate 200mcg/day in the first group (n:14), Mometasone furoate 200mcg/day plus oral Levocetirizine 5mg/day in the second group (n:21), and Mometasone furoate 200mcg/day plus oral Montelukast 10mg/day in the third group (n:21). We evaluated the patients before treatment and at the firstmonth after treatment with mini rhinoconjunctivitis quality of life questionnaire (miniRQLQ) and nasal symptom scores. In the first group nasal symptom and mini RQLQ scores were not improved but in second and third group, both scores were improved significantly (p<0.05). Nasal obstruction symptom score was better in the third group after treatment (p<0.01), but other nasal symptom scores (rhinorrhea, sneezing and nasal itching) were better in the second group (For each symptom p<0.05). Improvement of quality of life scores in the second group were better than the third group (p<0.05). In persistent allergic rhinitis, combination of levocetirizine or montelukast to nasal steroids was better than the topical mometasone furoate alone in terms of quality of life.

Evaluation of Clinical Features of Antrochoanal Polyps

Objective: Antrochoanal polyps (ACPs) are benign polypoid lesions that arise from the maxillary sinus and extend into the choana. Current knowledge regarding the prevalence and clinical features of ACPs in Japan is very limited. Here, we performed a prospective study to evaluate the prevalence and clinical features of ACPs. Method: Between April 2007 and March 2008, 728 patients undergoing endoscopic endonasal sinus surgery were prospectively enrolled in this study at the Department of Otorhinolaryngology, Jikei University School of Medicine. Results: Fifteen (2.1%) of those patients were diagnosed as having ACP(s). The symptom scores for nasal obstruction, rhinorrhea, and postnasal drip were each significantly reduced postoperatively. The distribution of the ACPs’ origin in the maxillary sinus was as follows: floor of the maxillary sinus to the posterior wall (40%), floor of the maxillary sinus (26.7%), and floor of the maxillary sinus to the internal wall (20%). The recurrence rate following endoscopic endonasal sinus surgery was 13.3%. Conclusion: Endoscopic endonasal sinus surgery for ACPs was most effective when the origin of the polyp in the maxillary sinus was carefully determined and excised as completely as possible, followed by appropriate postoperative treatment.

Carbon Dioxide-enriched Water Inhalation in Patients with Allergic Rhinitis and its Relationship with Nasal Fluid Cytokine/Chemokine Release

Allergic rhinitis is characterized by eosinophil infiltration and accumulation in the nasal mucosa mainly due to IL-3, IL-5, and eotaxin activities. We undertook this study to investigate a possible in vivo effect of carbon dioxide-enriched water inhalation in patients with allergic rhinitis. Twenty five consecutive patients inhaled carbon dioxide-enriched water at Fonti di Rabbi Spa Centre (Trento, Italy). Symptom scores for nasal obstruction, itching and sneezing were obtained before and after treatment. Nasal lavage was collected, and IL-3, IL-5, and eotaxin levels were assessed using the quantitative sandwich enzyme immunoassay technique. Cytometric analysis was performed on samples to measure total cell count, CD45+ cells, and percentages of polymorphonucleates and lymphocytes. There were statistically significant differences in chemokine levels and in cell populations between patients and healthy controls before treatment. After carbon dioxide-enriched water inhalation, we observed statistically significant improvements in symptom scores, chemokine levels, and percentages of cell populations. Our results seem to confirm the role of IL-3, IL-5, and eotaxin in the pathophysiology of allergy and the beneficial effect of carbon dioxide-enriched water inhalation in patients affected by allergic rhinitis.

Xylometazoline hydrochloride 0.1 per cent versus physiological saline in nasal surgical aftercare: a randomised, single-blinded, comparative clinical trial

A variety of topical preparations are used for symptomatic relief following nasal surgery. The aim of this study was to compare the effect of two commonly used products on patient symptom scores following nasal surgery. Randomised, single-blinded, comparative clinical trial. A single, secondary otorhinolaryngology centre. One hundred and twenty patients undergoing septoplasty or functional endoscopic sinus surgery as an isolated procedure between November 2003 and January 2006. Patients undergoing additional nasal procedures were excluded, as were those requiring additional post-operative medications other than standardised analgesia. Following nasal surgery, patients were randomised to receive either xylometazoline hydrochloride 0.1 per cent nasal spray or a sterile physiological saline aerosol. Visual analogue scale symptom scores for nasal obstruction, rhinorrhoea, pain, loss of sense of smell and bleeding were assessed at day 10 post-operatively. Post-operative symptom scores were compared between treatment groups. Overall, median pain scores were significantly higher in the xylometazoline group (p = 0.03, chi-square test). When analysed by procedure, median pain scores were significantly higher in septoplasty patients using xylometazoline (p = 0.019, chi-square test). There is no evidence to support the use of xylometazoline hydrochloride 0.1 per cent nasal spray over aerosolised physiological saline alone, following nasal surgery. Furthermore, there may be more pain associated with the post-operative use of xylometazoline.

Effect of ramatroban, a thromboxane A2 antagonist, in the treatment of perennial allergic rhinitis

ABSTRACT Background It is known that the symptoms of allergic rhinitis can significantly reduce the quality of life of the patient. One of such typical symptoms of allergic rhinitis is nasal obstruction. Nasal obstruction is currently thought to be closely related to the presence and abundance of lipid mediators, such as leukotriene and thromboxane (TX) A 2 . The novel drug ramatroban, a TXA 2 receptor antagonist, which has been developed by Bayer Yakuhin Ltd. (Osaka, Japan), has been demonstrated, in clinical trials, to improve nasal obstruction in the treatment of patients with allergic rhinitis and it has recently become commercially available. Methods In the present study, ramatroban was administered for 28 days to 10 patients who were diagnosed with perennial allergic rhinitis but were untreated. Changes in self-reported symptom scores and in vivo allergic reaction parameters were assessed during three observational periods. Results From baseline scores, all three symptom scores after 28 days treatment with ramatroban declined clearly in all patients, except for one patient who suffered a cold during the study period and had aggravated rhinorrhea and nasal obstruction as a result. The concentrations of histamine and TXB 2 (a metabolite of TXA 2 ) in the nasal fluid induced by antigen challenge after the 28 day treatment period also decreased in most subjects compared with concentrations during the pretreatment period. The symptom scores for nasal obstruction during the pretreatment period were correlated with the concentration of TXB 2 in antigen-induced nasal fluid. Conclusions The present study reconfirmed the clinical efficacy of a post-marketed drug, namely ramatroban, in the treatment of allergic rhinitis. In addition, the results suggest that ramatroban suppressed the secretion of chemical mediators in nasal that are thought to be involved in the allergic reaction in patients with perennial allergic rhinitis.

Impact and modulation of nasal obstruction.

Nasal obstruction, the leading symptom of allergic rhinitis, results from the combined activity of early- and late-phase allergic reactions. Desloratadine inhibits both early- and late-phase inflammatory mediators in vitro. Thus, double-blind, placebo-controlled, randomized, crossover trials were conducted to assess the efficacy of desloratadine against nasal obstruction, measured objectively and subjectively, during controlled exposure of patients with seasonal allergic rhinitis to allergen. Positive results were obtained in three single-dose studies; desloratadine 5 mg resulted in a greater improvement from baseline than did placebo in the total symptom score and the nasal obstruction symptom score (P </= 0.02). Desloratadine was more effective than placebo in a multiple-dose study; desloratadine 5 mg was given once daily for 7 days, and a 6-h allergen challenge was administered at the end of treatment compared with placebo. Desloratadine treatment was associated with less deterioration from baseline in the mean nasal airflow (P < 0.05) and in the mean severity score for the symptom of nasal obstruction (P < 0.03). Desloratadine significantly reduces the severity of nasal obstruction in patients with seasonal allergic rhinitis.

Pediatric Adenoidal Hypertrophy and Nasal Airway Obstruction: Reduction With Aqueous Nasal Beclomethasone

Pediatric adenoidal obstruction of the nasal airway is associated with significant morbidity and is a frequent indication for surgery. Because efficacious medical alternatives to adenoidectomy are lacking, we assessed the potency of standard-dose topical nasal beclomethasone in reduction of adenoidal obstruction of the nasal airway. Seventeen children, 5 to 11 years of age, exhibiting chronic obstructive nasal symptoms and a group mean (+/- SE) adenoid/choana ratio of 91 +/- 1% on rhinoscopic examination, completed an 8-week, double-blind, placebo-controlled crossover study of standard-dose aqueous nasal beclomethasone (total 336 micrograms/day) in the treatment of adenoidal hypertrophy. In a 16-week, open-label, follow-on study, subjects received beclomethasone 1 spray in each nostril twice daily (168 micrograms/day). Over the initial 4 weeks, improvements in the mean adenoidal obstruction of the choanae were significantly greater in the group receiving beclomethasone than in the group receiving placebo (right, -14.0% vs. +0.4%, P = .0002) (left, -15.0% vs. -2.0%, P = .0006). In the subsequent crossover 4 weeks, a significant beclomethasone carryover effect resulted in further adenoid size reduction in both treatment groups. All patients demonstrated a decrease in adenoid size with beclomethasone treatment, compared with a mixed response to placebo. Over the full 8-week crossover study, the mean (+/- SE) obstructive symptom score after beclomethasone treatment (20.5 +/- 3.0) was significantly improved compared to patients' initial (43.1 +/- 2.9) and placebo scores (31.1 +/- 4.2, P < or = .05), despite the active drug carryover effect into the placebo treatment period. Significant improvements in adenoidal obstruction and symptom scores over the 8-week crossover study were enhanced in the subsequent 16-week open-label period (P = .0001). By 24 weeks, an 82% reduction in group mean nasal obstruction symptom score accompanied a 29% mean reduction in adenoid/choana ratio. No clinical or demographic characteristic predicted a patient's degree of response to treatment. Properly administered aqueous nasal beclomethasone in standard doses can significantly reduce adenoidal hypertrophy and nasal airway obstructive symptoms in children.

Intranasal Fluticasone Propionate Is Effective and Well-Tolerated in Adolescents with Seasonal Allergic Rhinitis

This two-week, double-blind, randomized, parallel-group, placebo-controlled study examined the efficacy and tolerability of intranasal fluticasone propionate (200 mcg once daily or 100 meg twice daily) in 12- to 17-year-old adolescents (n = 243) with seasonal allergic rhinitis. Both clinician- and patient-rated symptom scores for nasal obstruction, sneezing, nasal itching, and rhinorrhea were significantly lower in the groups treated with intranasal fluticasone propionate compared with the placebo-treated group. Clinician ratings of overall response to therapy also were significantly more favorable for each intranasal fluticasone propionate dosing regimen compared with placebo. There were no statistically significant differences between the intranasal fluticasone propionate groups in nasal symptom scores or clinician-rated overall response to therapy. No severe or unusual adverse events were reported in any of the groups. Morning plasma cortisol concentrations after 2 weeks of therapy did not differ among...

Trimming of the inferior turbinates: a prospective long-term study

The aim of this study was to determine whether the initial benefits of radical trimming and anterior trimming of the inferior turbinates on nasal airflow persisted in the long term. Radical trimming significantly reduced nasal resistance at 2 months following operation (n = 12) (P less than 0.005). There was no significant change in nasal resistance over the next 20 months. Symptom scores for nasal obstruction also showed a significant reduction (n = 16) (P less than 0.005), at 2 months, and did not change significantly over the next 20 months. Radical trimming of the inferior turbinates is a highly effective operation in patients with hypertrophy of the inferior turbinates with few initial complications. However, further analysis of the data revealed that up to 20% of patients lose the initial subjective benefit of relief of nasal obstruction within 2 years of follow-up. Late onset crusting occurs in some patients though this is not directly attributable to an increase in nasal airflow. This study also concludes that anterior trimming of the inferior turbinates cannot be recommended as a form of treatment.