1
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Simmons JK, Nadeem W, Hsue VB, Chen HH, Lee MK. Evaluating post-rhinoplasty nasal obstruction treatment: The efficacy of VivAer radiofrequency ablation. Am J Otolaryngol 2024; 45:104338. [PMID: 38729012 DOI: 10.1016/j.amjoto.2024.104338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE Nasal 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. METHODS A 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. RESULTS The 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. CONCLUSIONS Temperature-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.
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Affiliation(s)
- Jordan K Simmons
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Wasiq Nadeem
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Victor B Hsue
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Henry H Chen
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Matthew K Lee
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
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2
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Harvey RJ, Roland LT, Schlosser RJ, Pfaar O. Chief Complaint: Nasal Congestion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1462-1471. [PMID: 38677589 DOI: 10.1016/j.jaip.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.
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Affiliation(s)
- Richard John Harvey
- Rhinology & Skull Base, University of New South Wales and Macquarie University, Sydney, Australia.
| | - Lauren T Roland
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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3
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Yong M, Hollemon D, Baxter J, Hirst A, Bryning S, Fox A, Smith G, Hughes R, Brandolini G, Wolf S, Ow R. Economic impact analysis of a minimally invasive temperature-controlled radiofrequency device versus nasal surgery for the treatment of nasal airway obstruction in the United States. J Med Econ 2024; 27:708-714. [PMID: 38581156 DOI: 10.1080/13696998.2024.2340385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To determine the economic impact of a minimally invasive temperature-controlled radiofrequency (TCRF) device for treating nasal airway obstruction (NAO). METHODS A budget impact model was developed for two scenarios: a reference scenario of functional rhinoplasty surgery with concomitant septoplasty and inferior turbinate reduction (ITR) performed in the hospital outpatient department where TCRF is not an available treatment option and a new scenario consisting of in-office TCRF treatment of the nasal valve and ITR. A payor perspective was adopted with a hypothetical population plan size of one million members. Costs were estimated over a time horizon of 4 years. The eligible population included patients with severe/extreme NAO and nasal valve collapse (NVC) as the primary cause or significant contributor. Data inputs were sourced from targeted literature reviews. Uncertainty within the model structure and input parameters was assessed using one-way sensitivity analysis. RESULTS The introduction of a TCRF device resulted in population-level cost savings of $20,015,123 and per-responder average cost savings of $3531 through a 4-year time horizon due to lower procedure costs and complication rates of the device relative to the surgical comparator. Results were robust when varying parameter values in sensitivity analyses, with cost savings being most sensitive to the prevalence of NAO and estimated response rates to functional rhinoplasty and TCRF. CONCLUSIONS In patients with severe/extreme NAO, with NVC as the primary or major contributor, introducing TCRF with ITR as a treatment option demonstrates the potential for significant cost savings over functional rhinoplasty with septoplasty and ITR.
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Affiliation(s)
| | | | | | | | | | - Aimee Fox
- Adelphi Values PROVE, Bollington, UK
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4
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Navaratnam AV, Pendolino AL. Septoplasty for nasal obstruction. BMJ 2023; 383:2341. [PMID: 37852637 DOI: 10.1136/bmj.p2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Annakan V Navaratnam
- Department of Ear, Nose and Throat, Royal National ENT and Eastman Dental Hospitals, London WC1E 6DG, UK
| | - Alfonso Luca Pendolino
- Department of Ear, Nose and Throat, Royal National ENT and Eastman Dental Hospitals, London WC1E 6DG, UK
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5
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Raithatha R, Del Signore A. Prevalence and Identification of Nasal Airway Obstruction in Patients Presenting to Otolaryngology Clinics: Results From a Large Descriptive Practice Survey. EAR, NOSE & THROAT JOURNAL 2023:1455613231196670. [PMID: 37705360 DOI: 10.1177/01455613231196670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Objective: Determine the prevalence of nasal airway obstruction (NAO) in patients presenting to general otolaryngology clinics using the Nasal Obstruction Symptom Evaluation Scale (NOSE) score as a screening tool. Study Design: The clinic staff at 149 otolaryngology specialty clinics geographically distributed in the United States administered the NOSE Scale assessment to 3533 patients presenting to the clinics over a period of 1 week, regardless of the reason for the visit. All patients completed the NOSE Scale score, and additional data were collected, including the primary reason for the visit. Demographic and patient characteristics were summarized using frequencies and percentages for categorical variables. Results: The overall mean NOSE Scale score for the 3533 patients surveyed was 37.6 (SD 31.5). A total of 37.4% (1320/3533) of surveyed patients, regardless of visit reason, had severe/extreme NAO symptoms. Overall, the most common visit reason category was "Other" (61.2%, 2162/3533), followed by "NAO" (22.6%, 798/3533) and "Sinus" (16.2%, 573/3533). The mean NOSE scores for patients in each of the visit categories were 23.4 (SD 25.9), 64.7 (SD 23.3), and 53.3 (SD 28.1); for "Other," "NAO," and "Sinus," respectively. Among the patients coming in with "NAO" or "Sinus" as a primary complaint, 76.2% (608/798) and 57.2.% (328/573) had severe or extreme NOSE scores. A total of 17.8% (384/2162) of patients coming in for "Other" reasons had NOSE scores indicating severe/extreme NAO symptoms. Conclusions: The findings of this large, descriptive otolaryngology practice survey found a high prevalence of moderate to severe/extreme NAO among patients presenting to otolaryngology practices. Incorporating assessments, such as the NOSE Scale score and other diagnostic practices into the patient intake workflow and assessments, could help identify symptomatic NAO patients that might otherwise be overlooked.
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Affiliation(s)
- Roheen Raithatha
- ENT and Allergy Associates, New York, NY, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Del Signore
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Wilkins SG, Sheth AH, Kayastha D, Abdou H, Salehi PP, Citardi MJ, Peter Manes R. Adverse Events Associated With Bioabsorbable Nasal Implants: A MAUDE Database Analysis. Otolaryngol Head Neck Surg 2023; 168:1253-1257. [PMID: 36939542 DOI: 10.1002/ohn.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 01/29/2023]
Abstract
Bioabsorbable implants (eg, Latera) have recently been approved for addressing nasal valve collapse. The purpose of this study is to summarize adverse events and treatment sequelae associated with bioabsorbable nasal implants queried in the Manufacturer and User Facility Device Experience (MAUDE) database. Of the 26 device reports entered between March 2017 and April 2022, the most frequently reported complications included abscess (n = 13) and implant protrusion (n = 5). Other common symptoms reported greater than 1-year postimplantation included facial pain/discomfort (n = 3) and failure to absorb (n = 3). Management of adverse events included treatment with antibiotics (n = 9), steroid injections (n = 4), and explantation (n = 20). In 3 reports, adverse reactions required a biopsy of adjacent tissue for pathologic analysis. These findings suggest that further research is required to assess the potential long-term complications and optimize the management of bioabsorbable nasal implants. Furthermore, standardized reporting templates may improve the utility of the MAUDE database.
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Affiliation(s)
- Sarah G Wilkins
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amar H Sheth
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Darpan Kayastha
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hisham Abdou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Parsa P Salehi
- Nassif MD Plastic Surgery, Beverly Hills, California, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - R Peter Manes
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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7
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Czachor A, Diaz JD, Cho SH, Lockey RF. The Use of Flexible Rhinolaryngoscopy for Allergy-Immunology Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:149-157.e1. [PMID: 36154896 DOI: 10.1016/j.jaip.2022.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023]
Abstract
Flexible rhinolaryngoscopy is an underused procedure that can provide allergists-immunologists and other physicians with several benefits over existing imaging techniques. In this article, we highlight the many benefits of flexible rhinolaryngoscopy and expand on its safety, cost-effectiveness, and convenience. This article also covers current procedure techniques and assesses the most common indications and relevant clinical findings for which flexible rhinolaryngoscopy can be used to evaluate the nasopharyngeal tract. Videos for the clinician showing some of the most common findings are included.
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Affiliation(s)
- Alexander Czachor
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Joseph D Diaz
- Allergy and Asthma Research Center, San Antonio, Texas; Department of Medicine, Pulmonary Division, University of Texas Health at San Antonio, San Antonio, Texas
| | - Seong H Cho
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla
| | - Richard F Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
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8
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Jacobowitz O, Ehmer D, Lanier B, Scurry W, Davis B. Long-term outcomes following repair of nasal valve collapse with temperature-controlled radiofrequency treatment for patients with nasal obstruction. Int Forum Allergy Rhinol 2022; 12:1442-1446. [PMID: 35731832 PMCID: PMC9796562 DOI: 10.1002/alr.23019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Ofer Jacobowitz
- ENT and Allergy Associates and department of OtolaryngologyZucker School of MedicineHofstra UniversityNew YorkNew YorkUSA
| | | | - Brent Lanier
- Central California Ear, Nose, and ThroatFresnoCaliforniaUSA
| | - William Scurry
- Piedmont Ear Nose and Throat AssociatesWinston‐SalemNorth CarolinaUSA
| | - Bryan Davis
- Colorado ENT and AllergyColorado SpringsColoradoUSA
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9
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Clark CM, Hakimi AA, Parsa KM, Tanenbaum Z, Wang H, Chu E, Reilly MJ. Comparison of Nasal Obstruction Symptom Evaluation Score Outcomes After Autologous Cartilage Grafts and Latera Nasal Implants. Ann Otol Rhinol Laryngol 2022:34894221121405. [DOI: 10.1177/00034894221121405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. Methods: Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. Results: There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). Conclusions: Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.
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Affiliation(s)
- Christine M. Clark
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Amir A. Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Keon M. Parsa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Haijun Wang
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC, USA
| | - Eugenia Chu
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael J. Reilly
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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10
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Deot N, Obayemi A, Davila R. Non-Surgical Devices for Nasal Obstruction. Facial Plast Surg 2022; 38:359-363. [PMID: 35445382 DOI: 10.1055/a-1830-2533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Nasal obstruction is a common presenting complaint in most otolaryngology practices. A reduction of nasal airflow can contribute to exercise intolerance, snoring, obstructive sleep apnea (OSA), and an overall decreased in quality of life. When medical management for non-anatomic issues fail to resolve the obstruction, surgeries targeting nasal obstruction-- namely septorhinoplasty and/or inferior turbinate reduction are often considered. A frequently overlooked alternative for these patients is the wide array of non-surgical and minimally invasive appliances available to address nasal obstruction. This article attempts to provide a basic overview of these devices, benefits and limitations, and the evidence supporting their efficacy in alleviating nasal obstruction.
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Affiliation(s)
- Neal Deot
- Otolaryngology, Upstate University Hospital, Syracuse, United States
| | | | - Rich Davila
- Otolaryngology, Upstate University Hospital, Syracuse, United States
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11
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Yang A, Kim D, Tsai E, Chang MT, Low CM, Ibrahim N. The Nasal Vestibular Body and Its Role in Nasal Obstruction. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Nasal Obstruction Evaluation After LeFort I Osteotomy: A Pilot Study. J Craniofac Surg 2021; 33:101-103. [PMID: 34967516 DOI: 10.1097/scs.0000000000008048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Previous literature has documented changes in nasal obstruction after acute LeFort I osteotomy. However, there is a paucity of studies that evaluate distraction-mediated LeFort I (DO-LFI) without concomitant intranasal interventions using the nasal obstruction symptom evaluation (NOSE) scale in Class III patients. The purpose of this study is to objectively evaluate nasal obstruction quality of life through the NOSE scale in patients undergoing DO-LFI. Inclusion into the study required both a preoperative (1 year ≤ date of service) and postoperative (≥6 months and ≤2 years) NOSE scale administration. Nasal obstruction symptom evaluation scales were compared using Wilcoxon signed rank test. There was a significant difference in composite NOSE scales, x̃ = 8.0 (interquartile range: 4.0-11.0), x̃ = 1.0 (interquartile range: 1.0-3.0), P < 0.017, preoperatively and postoperatively respectfully. Additionally, when looking at individual components of the NOSE scale, nasal congestion or stuffiness, and trouble breathing through nose were significantly improved after DO-LFI (P < 0.017). Nasal blockage or obstruction (P > 0.084) and trouble breathing when exercising (P > 0.076) trended towards significant improvement, as well. Trouble sleeping did not differ, P > 0.611. We elucidate, in this pilot study, that there is an association between DO-LFI and patient reported nasal obstructive symptoms. Future prospective studies utilizing the NOSE scale are needed to determine causality.
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13
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Liu JF, Yan ZF, Zhang ZJ, Wang NY. Septoplasty alone is not suitable for most structural nasal obstructions. World J Otorhinolaryngol Head Neck Surg 2021; 7:322-327. [PMID: 34632347 PMCID: PMC8486691 DOI: 10.1016/j.wjorl.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Septoplasty is widely used in the treatment of structural nasal obstructions, and it also has a good effect and a high degree of postoperative satisfaction. However, there a large number of structures demonstrate abnormalities related to structural nasal obstruction, including the external nose, maxilla, nasal cavity and paranasal sinus. Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure. Septoplasty is only performed to correct deviations of the nasal septum, which in many cases is obviously insufficient in restoring the symmetry of the nasal structure. Therefore, septoplasty alone is not suitable for the treatment of most structural nasal obstructions. Nasal ventilation expansion surgery, which typically covers more abnormal structural correction procedures than septoplasty, should be used when describing the treatment of structural nasal obstruction.
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Affiliation(s)
- Jin-Feng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhan-Feng Yan
- Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Zhi-Jin Zhang
- The Third Clinical Medical School, Capital Medical University, Beijing, 100009, China
| | - Ning-Yu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
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14
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Harounian JA, Yu D, Lu X, Friedman O. Variation in Practice Patterns of Current Rhinoplasty Surgeons for Nasal Valve Compromise. Facial Plast Surg Aesthet Med 2021. [PMID: 34495760 DOI: 10.1089/fpsam.2021.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To compare practice patterns of rhinoplasty surgeons with the 2010 clinical consensus statements (CCSs) on nasal valve compromise (NVC) and delineate what variables may affect such practice patterns and consensus. Methods: An online questionnaire pertaining to the 2010 CCS was administered at the Advances in Rhinoplasty meeting with responses based on a 9-point Likert scale. Results: Of 580 participants, 113 completed the survey with the majority of statements in accordance between panelists and surveyors. Less than 10% of responses met discordance criteria. Significant differences in practice patterns exist when stratified by specialty, years-in-practice, geographic location, type of practice, and annual number of rhinoplasties performed. Conclusion: There is a general concordance between practice patterns of active rhinoplasty surgeons and the 2010 CCS on NVC despite a decade of new studies in the interim. Significant differences, however, exist regarding the utility of diagnostic imaging, rhinoscopy, nasal endoscopy, and acoustic rhinomanometry in the evaluation of NVC. Furthermore, variables such as specialty, years in practice, annual number of rhinoplasties performed, practice setting, and geographic location significantly affect these perspectives and overall consensus.
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Affiliation(s)
- Jonathan A Harounian
- Department of Otolaryngology-Head and Neck Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Daohai Yu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Xiaoning Lu
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Oren Friedman
- Facial Plastic Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Hosseini S, Schuman TA, Walenga R, Wilkins JV, Babiskin A, Golshahi L. Use of anatomically-accurate 3-dimensional nasal airway models of adult human subjects in a novel methodology to identify and evaluate the internal nasal valve. Comput Biol Med 2020; 123:103896. [PMID: 32768043 DOI: 10.1016/j.compbiomed.2020.103896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022]
Abstract
The optimal method for radiographic evaluation of the internal nasal valve (INV) has not been established. The objective of this study was to develop a method to assess the cross-sectional area and the angle of the INV using anatomically-accurate 3D digital nasal airway models. Axial CT images of the paranasal sinuses of twenty adult subjects with healthy nasal airways (50% female and 50% age ≥ 50) were used to create the models. Patients with significant radiographic evidence of sinonasal disease were excluded. A primary cutting plane that passed through the edge of the nasal bone, upper lateral cartilage, and the head of the inferior turbinate was defined in coronal view. This primary coronal cutting plane was then rotated in 5° increments anteriorly while ensuring the anatomic criteria for the INV were still met. The cutting plane resulting in the minimum INV area was identified as the optimal cutting plane and the total cross-sectional area of INV in this plane,198.79 ± 54.57 mm2, was significantly less than the areas obtained using the existing methods for radiographic evaluation of the INV. The angle between the optimal cutting plane and nasal dorsum was 75.00 ± 10.26°, and the corresponding INV angle was 10.77 ± 6.02°.
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Affiliation(s)
- Sana Hosseini
- Department of Mechanical and Nuclear Engineering, VCU, Richmond, VA, USA
| | - Theodore A Schuman
- Department of Otolaryngology- Head and Neck Surgery, VCU Health, Richmond, VA, USA
| | - Ross Walenga
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - John V Wilkins
- Department of Mechanical and Nuclear Engineering, VCU, Richmond, VA, USA
| | - Andrew Babiskin
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Laleh Golshahi
- Department of Mechanical and Nuclear Engineering, VCU, Richmond, VA, USA.
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16
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Yoon A, Abdelwahab M, Liu S, Oh J, Suh H, Trieu M, Kang K, Silva D. Impact of rapid palatal expansion on the internal nasal valve and obstructive nasal symptoms in children. Sleep Breath 2020; 25:1019-1027. [PMID: 32648185 DOI: 10.1007/s11325-020-02140-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the impact of rapid palatal expansion (RPE) on the nasal airway subjectively by utilizing patient-reported outcome measures (PROM) and objectively by evaluating validated internal nasal valve (INV) measurements obtained from cone beam computed tomography (CBCT) in pediatrics. MATERIALS AND METHODS In this retrospective cohort study, subjects who underwent RPE from March to December 2018 with cone beam CT and Nasal Obstruction Symptom Evaluation (NOSE) scores were included. Exclusion criteria included craniofacial deformity, allergies, asthma, recent nasal trauma, or surgery. INV measurements (angle and cross-sectional area), diastema, midpalatal suture opening, and NOSE scores were evaluated. RESULTS Fifty-one subjects met the inclusion criteria with a mean age of 10.1 ± 2.6. Pre-expansion mean NOSE score was 32.55 (moderate) while post-expansion was 13.92 (mild). Mean NOSE score improved significantly by an average of 18.63 following post-expansion (P < 0.0001). The patients' right and left INV angles increased significantly by a mean of 2.42° and 2.65° respectively (P < 0.0001). Right and left INV cross-sectional areas increased significantly by an average of 14.35 mm2 (P < 0.0001) and 14.17 mm2 (P < 0.0001) respectively. An average expansion of the diastema and the suture was 1.60 mm and 3.05 mm respectively (P < 0.0001), with an average of 6.29 mm of expansion. We found the amount of diastema expansion to correlate with change in NOSE score (R = - 0.32, P = 0.022). Age and diastema showed a negative correlation (R = - 0.44, P = 0.0019), while INV angle and diastema showed a statistically significant positive correlation (R = 0.28, P = 0.048). CONCLUSIONS RPE showed improvement in both NOSE scores and objective measures of the INV. This may show the possibility of considering RPE in managing resistant pediatric nasal airways. Future studies should include collaboration with pediatric otolaryngologists, with the inclusion of pediatric patients with persistent nasal obstruction.
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Affiliation(s)
- Audrey Yoon
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.,Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, 94103, USA
| | - Mohamed Abdelwahab
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA.,Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Stanley Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - James Oh
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Heeyeon Suh
- Department of Orthodontics, Arthur A. Dugoni School of Dentistry at the University of the Pacific, San Francisco, CA, 94103, USA
| | - Michael Trieu
- UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Kevin Kang
- UCLA School of Dentistry, Los Angeles, CA, 90095, USA
| | - Daniela Silva
- Sections of Pediatric Dentistry and Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, CA, 90095, USA.
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17
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Ibrahim N, Tyler MA, Borchard NA, Rathor A, Nayak JV. Nasal vestibular body treatment for recalcitrant nasal obstruction. Int Forum Allergy Rhinol 2020; 10:388-394. [PMID: 32017469 DOI: 10.1002/alr.22463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The nasal vestibular body (NVB) is a recently reported dynamic swell body present in the inferolateral internal nasal valve. The contribution of NVB presence to persistent nasal obstruction, and effects of NVB treatment, are undefined. METHODS Thirty-five patients with recalcitrant nasal obstruction and NVB presence were retrospectively reviewed between 2013 and 2019, including 25 patients (48 sides) who had NVBs reduced via radiofrequency ablation (RFA) and 10 patients (20 sides) who had untreated NVBs. Posttreatment healing and complications were reviewed at early (<1 month) and late (mean, 7.3 months) time-points after RFA of the NVB. A subset of the NVB-treatment patients (18 of 25 patients) were compared with 10 NVB-control patients for pre-/posttreatment outcomes using 22-item Sino-Nasal Outcome Test (SNOT-22) and subdomain scoring. RESULTS NVBs were successfully reduced in 100% of cases (48 of 48 sides) over both time-points. Early sequelae of NVB treatment, such as local crusting (22 of 23, 95.6%) and bone exposure (4 of 23, 17.3%), resolved by the late time-point, with complete remucosalization (23 of 23, 100%) of all NVB treatment sites. No persistent pain, sensory loss, or pyriform aperture stenosis was noted from any patient/side. Significant reductions between mean pre- and postoperative SNOT-22 (-24, p = 0.001) and individual subdomain (-2, p = 002) scores were seen in the NVB-treatment patients compared to the reductions in NVB-controls (-8 and -1, respectively, both p > 0.001). CONCLUSION NVB treatment using RFA is safe and highly effective, providing complete swell body reduction with only transient local morbidity. NVB presence contributes to persistent/recalcitrant nasal obstruction, with significant improvement in nasal airway function noted after NVB soft tissue reduction.
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Affiliation(s)
- Nour Ibrahim
- Department of Otolaryngology, Galilee Medical Center, Nahariyya, Israel.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Nicole A Borchard
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Aakanksha Rathor
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
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18
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Whyte A, Boeddinghaus R. Imaging of adult nasal obstruction. Clin Radiol 2019; 75:688-704. [PMID: 31515050 DOI: 10.1016/j.crad.2019.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
The commonest causes of nasal obstruction are rhinitis and chronic rhinosinusitis, which affect up to 30% and 14% of the adult population, respectively. The global financial burden is huge, estimated at $5 billion for rhinitis and $8.6 billion for chronic rhinosinusitis per annum in the USA. On referral for imaging, computed tomography (CT) is indicated initially when there is a suboptimal response to medical treatment of these mucosal diseases or there are "red flags," such as persistent unilateral obstruction, epistaxis, pain, and orbital or neurological symptoms. A mass visible at rhinoscopy or endoscopy in the nose or nasopharynx and lymphadenopathy are further indications. The anterior (cartilaginous) nose plays a key role in the aetiology of nasal obstruction as it accounts for 50-75% of the total resistance to airflow in the upper airway. It has been ignored in the imaging literature, but extensively evaluated by clinicians using a range of methods, including CT. Oblique reconstructions perpendicular to the parabolic curve of lamellar airflow provide accurate assessment of the anterior nose. A thorough and systematic approach to assessing the nose addresses the discrepancy between imaging and clinical evaluation of structural causes of nasal obstruction, especially septal deviation, reported in the surgical literature. Nasal tumours are a very uncommon cause of nasal obstruction; magnetic resonance imaging is commonly performed to assess their full extent and improve the specificity of diagnosis.
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Affiliation(s)
- A Whyte
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Radiology and Medicine, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - R Boeddinghaus
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia
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Sidle DM, Stolovitzky P, Ow RA, Silvers S, Matheny K, Bikhazi N, Wani M, Scurry WC, Most SP. Twelve-month outcomes of a bioabsorbable implant for in-office treatment of dynamic nasal valve collapse. Laryngoscope 2019; 130:1132-1137. [PMID: 31254279 PMCID: PMC7217163 DOI: 10.1002/lary.28151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 01/31/2023]
Abstract
Objectives To examine 12‐month outcomes for in‐office treatment of dynamic nasal valve collapse (NVC) with a bioabsorbable implant. Study Design Prospective, multicenter, nonrandomized study. Methods One hundred sixty‐six patients with severe‐to‐extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 16 U.S. clinics (November 2016–July 2017). Patients were treated with a bioabsorbable implant (Latera, Spirox Inc., Redwood City, CA) to support the lateral wall, with or without concurrent inferior turbinate reduction (ITR), in an office setting. NOSE scores and Visual Analog Scale (VAS) were measured at baseline and 1, 3, 6, and 12 months postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video. Results One hundred five patients were treated with implant alone, whereas 61 had implant + ITR. Thirty‐one patients reported 41 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores throughout 12 months postoperatively (77.4 ± 13.4 baseline vs. 36.2 ± 22.7 at 1 month postoperatively, 33.0 ± 23.4 at 3 months, 32.1 ± 24.6 at 6 months, and 30.3 ± 24.3 at 12 months; P < 0.001). They also showed significant reduction in VAS scores postoperatively (69.7 ± 18.1 baseline vs. 31.3 ± 27.1 at 12 months postoperatively, P < 0.001). These results were similar in patients treated with implant alone and those treated with the implant + ITR. Consistent with patient‐reported outcomes, postoperative LWI scores were demonstrably lower (1.42 ± 0.09 and 0.93 ± 0.08 pre‐ and postoperatively, P < 0.001). Conclusion In‐office treatment of dynamic NVC with a bioabsorbable implant improves clinical evidence of LWI at 6 months and improves nasal obstructive symptoms in a majority of patients up to 12 months. Level of Evidence 2b Laryngoscope, 130:1132–1137, 2020
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Affiliation(s)
- Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- the Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Randall A Ow
- the Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | - Stacey Silvers
- the Madison ENT & Facial Plastic Surgery, New York, New York
| | - Keith Matheny
- the Collin County Ear, Nose and Throat, Frisco, Texas
| | | | | | - W Cooper Scurry
- Piedmont Ear, Nose & Throat Associates, PA, Winston-Salem, North Carolina, U.S.A
| | - Sam P Most
- the Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
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