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Taha HI, Elgendy MS, Ezz MR, Tolba K, El Safty M, Azzawi MADA, Katamesh BE, Albazee E. Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08937-x. [PMID: 39230606 DOI: 10.1007/s00405-024-08937-x] [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: 07/05/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). METHODS We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). RESULTS Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. CONCLUSIONS This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.
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Affiliation(s)
- Hosam I Taha
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Khalid Tolba
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Basant E Katamesh
- Faculty of Medicine, Tanta University, Tanta, Egypt
- Research Scholar, Mayo Clinic, Rochester, MN, USA
| | - Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.
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Rot P, Krzywdzińska S, Grab P, Jurkiewicz D, Chloupek A, Sobol M. The Rhinoplasty Outcome Evaluation (ROE) Questionnaire in Rhinoplasty: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4642. [PMID: 39200785 PMCID: PMC11355392 DOI: 10.3390/jcm13164642] [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: 06/07/2024] [Revised: 07/07/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: This study aims to systematize the ability to use ROE to assess rhinoplasty outcomes in surgical approaches. Methods: The PubMed, Scopus, and Web of Science databases were searched for the following terms: "rhinoplasty and outcome" OR "prognosis" OR "outcomes" OR "satisfaction" OR "quality of life" OR QoL "rhinoplasty outcome evaluation". The timeframe of the included studies is from 2011 to May 2024. Ultimately, 17 papers were included in the conducted meta-analysis of ROE scores between pre- and post-treatment data. Results The mean value of the pre-treatment ROE score was 33.50 with a CI of 29.46 to 37.53 (p < 0.001), while the post-treatment ROE was 69.60 with a CI of 63.07 to 76.14 (t ≤ 6 months). At t = 12 months it was 80.25 with a CI of 75.79 to 84.70 (p < 0.001). The mean difference between pre-treatment and post-treatment scores (t ≤ 6 months) was -36.31 with a CI of -40.93 to -31.69. The mean difference between pre-treatment and post-treatment scores for 6 m < t ≤ 12 m was -47.36 with a CI of -53.89 to -40.83. Conclusions: The result was statistically significant (p < 0.001).
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Affiliation(s)
- Piotr Rot
- Clinic of Otolaryngology and Oncological Otolaryngology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warszawa, Poland; (P.R.)
| | - Sandra Krzywdzińska
- Clinic of Otolaryngology and Oncological Otolaryngology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warszawa, Poland; (P.R.)
| | - Paweł Grab
- Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warszawa, Poland
| | - Dariusz Jurkiewicz
- Clinic of Otolaryngology and Oncological Otolaryngology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warszawa, Poland; (P.R.)
| | - Aldona Chloupek
- Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine-National Research Institute, 04-141 Warszawa, Poland
| | - Maria Sobol
- Department of Biophysics, Physiology and Pathophysiology, Medical University of Warsaw, 02-091 Warszawa, Poland
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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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Fearington FW, Awadallah AS, Hamilton GS, Olson MD, Dey JK. Long-Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review. Laryngoscope 2024; 134:2525-2537. [PMID: 37991145 DOI: 10.1002/lary.31193] [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: 09/19/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long-term efficacy of septoplasty is unclear, and no literature reviews have examined long-term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long-term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. DATA SOURCES PubMed, EMBASE, Cochrane CENTRAL. METHODS A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. RESULTS After screening, 35 studies with 4,432 patients were included. Mean weighted post-operative follow-up time was 29.1 months (range 12-120 months). All studies reported significant improvement in subjective and objective outcomes at long-term follow-up compared to baseline. When comparing short-term (<12 months) to long-term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. CONCLUSIONS Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long-term follow-up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2525-2537, 2024.
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Affiliation(s)
| | | | - Grant S Hamilton
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael D Olson
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jacob K Dey
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Migliavacca RDO, Lavinsky M, de Souza OE, Friedrich EP, Cionek OAGD, Subda LF, Bernardi BL. Modified extracorporeal septoplasty: prospective study. Braz J Otorhinolaryngol 2024; 90:101398. [PMID: 38430860 PMCID: PMC10912845 DOI: 10.1016/j.bjorl.2024.101398] [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: 08/22/2023] [Revised: 11/13/2023] [Accepted: 12/26/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES This study aimed to evaluate quality-of-life and satisfaction outcomes in patients undergoing the MES using the Portuguese version of the Nasal Obstruction Symptom Evaluation (NOSE-p) and Rhinoplasty Outcome Evaluation (ROE), and also to evaluate the frequency of possible complications of this technique. METHODS We conducted a single-center prospective study with patients who had the indication for MES, from May 2016 to September 2020 at the Facial Plastic Surgery Clinic of Otolaryngology Department of the Hospital de Clinicas de Porto Alegre. The primary outcome was the relative postoperative change in NOSE-p. Secondary outcome was the variation in ROE, a validated quality-of-life questionnaire for rhinoplasty patients. RESULTS Of the 31 patients submitted to extracorporeal septorhinoplasty who were evaluated, twenty-seven patients were included. Preoperative and postoperative NOSE-p scale scores were 65.2 ± 29.9 and 23.5 ± 26.7, respectively (mean differences of 42.04; [95% CI 27.35-56.73]; p < 0.0001). Pre and postoperative ROE scores were 38.3 ± 24.3 vs. 67.29 ± 29.7, respectively (mean differences of -29.02; [95% CI -40.5 to -17.5]; p = 0.0001). Residual septal deviation was verified in 2 patients (7.4%). CONCLUSION Most of the patients submitted to modified extracorporeal septoplasty had a significant improvement in quality of life scores of nasal obstruction, with good aesthetical outcomes and low indices of postoperative complications. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Raphaella de Oliveira Migliavacca
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil
| | - Michelle Lavinsky
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Olívia Egger de Souza
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Eduardo Priesnitz Friedrich
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | - Otávio Augusto Gonçalves Dias Cionek
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Leonardo Ferreira Subda
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Bárbara Luiza Bernardi
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Otorrinolaringologia, Programa de Pós-Graduação em Ciências Médicas: Otorrinolaringologia, Porto Alegre, RS, Brazil
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Li W, Misra S, Harvey RJ, Kalish L. Long-term treatment outcomes in refractory rhinitis medicamentosa managed with nasal surgery. Int Forum Allergy Rhinol 2024; 14:630-638. [PMID: 37449456 DOI: 10.1002/alr.23240] [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: 04/05/2023] [Revised: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Limited treatment options exist for refractory Rhinitis Medicamentosa (RM). The role of surgery after failed medical management is not well defined. Mucosal contact points and restricted airflow often perpetuate decongestant use. This study assessed the long-term outcomes of nasal surgery in patients with refractory RM. METHODS A prospective cohort study of refractory RM treated with nasal surgery was performed with ≥12 months follow-up. Refractory RM was defined as nasal decongestant use once per day continuously for ≥4 weeks despite medical therapy. Patients with concomitant sinus disease and nonrhinitis conditions were excluded. Sinonasal Outcome Test (SNOT22), Nasal Symptom Score (NSS), and nasal medication use were assessed. Patients who ceased decongestants were compared with ongoing users. RESULTS A total of 56 patients (age 48.4 [5.0] years, 50% female) were assessed. Median follow-up was 3.4(1.6-6.2) years. Total cessation of decongestants was achieved in 91.1%, while 5.4% had intermittent use, and 3.6% reported daily use. Ongoing users had higher odds of concomitant asthma (40.0% vs. 3.9%; odds ratio [OR], 16.33 [1.7-159.75]; p = 0.036), reduced symptom improvement (ΔSNOT22, -4.6 [15.7] vs. 27.1 [17], p = 0.009 and ΔNSS, -1.0 [4.2] vs. -6.6 [5.1], p = 0.025), and greater ongoing use of nasal corticosteroid (60.0% vs. 5.9%; OR 24.0 [2.8-203.1]) and saline sprays (40% vs. 3.9%; OR 16.3 [1.7-159.8]) but showed no difference in allergy status (OR, 0.7[0.1-7.1]), previous surgery (OR, 1.0[0.1-10.2]), gastroesophageal reflux (OR 1.0[0.1-10.2], or underlying anxiety/depression (OR 6.1[0.8-45.9]) compared with those who ceased. CONCLUSION Surgically re-establishing a nasal airway was associated with long-term decongestant cessation and symptom improvement in medically refractory RM.
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Affiliation(s)
- William Li
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Shibalik Misra
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Richard John Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Alghanem B, Almotairi N, Alrasheedi A. Septoplasty and Nasal Packs From Otolaryngologists' Perspectives: A Cross-Sectional Survey. Cureus 2024; 16:e54691. [PMID: 38523933 PMCID: PMC10960617 DOI: 10.7759/cureus.54691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Septoplasty is a commonly performed surgery by otolaryngologists. This study examines the routine use of non-absorbable nasal packs in the postoperative period in Kuwait. Our aim is to assess the views of otolaryngologists in Kuwait regarding the routine use of non-absorbable nasal packing after septoplasty with or without turbinoplasty. Materials and methods A cross-sectional study, an anonymous survey, consisting of 10 questions, using Google Forms was conducted. It was distributed via WhatsApp and in person hard copies to otolaryngologists - head and neck surgeons in Kuwait. Data were securely stored and analyzed using Stata (StataCorp LLC, College Station, Texas) software. Results Fifty participants have completed the survey. The majority were routinely performing septoplasty for a symptomatic deviated nasal septum (n= 47, 94%). Out of those, 43% (n = 21) usually use silastic splints to prevent postoperative complications, including bleeding, hematoma formation, and adhesions. The use of quilting sutures for the same purpose was done by 21% (n = 10), and 17% (n = 8) used non-absorbable nasal packs. Only two participants believed that no specific intervention was required. More than half used postoperative nasal packs in the case of intra-operative bleeding (n=26, 52%), while 18% (n = 9) believed that it is only necessary in selected cases with predisposing factors to bleeding. Ninety-two percent (n = 46) thought that pain and discomfort were associated with the use of non-absorbable nasal packs, and 50% (n = 25) believed that it could cause hemodynamic instability. Moreover, 66% (n = 33) agreed that quilting or trans-septal sutures can safely substitute nasal packs following septoplasty. Awareness of recent updates on the complications related to nasal packing varied, with more than half of the otolaryngologists being knowledgeable (n = 29, 58%). Discussion Septoplasty, a common surgical intervention for correcting a misaligned nasal septum, addresses various symptoms, such as nasal obstruction, obstructive sleep apnea, epistaxis, and headache. While the practice of nasal packing for 24-48 hours post-septoplasty is widespread, it remains a topic of controversy. Current literature supports the continued use of nasal packing for patients at high risk of bleeding. However, potential drawbacks, including increased pain, headache, and prolonged hospital stay, raise concerns about its overall benefits. An alternative approach, utilizing quilting sutures without nasal packs, has shown promising results in comparative studies, demonstrating less pain and minimal bleeding. Additionally, trans-septal sutures emerge as a safe alternative, minimizing dead space and reducing post-operative complications. Conclusion It appears that otolaryngologists in Kuwait have diverse opinions with regard to nasal packing following septoplasty. Further research is needed to establish evidence-based guidelines for this common procedure.
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Affiliation(s)
- Balqees Alghanem
- Otolaryngology - Head and Neck Surgery, Kuwait Institute for Medical Specializations, Kuwait, KWT
| | - Nawaf Almotairi
- Otorhinolaryngology - Head and Neck Surgery, Farwaniya Hospital, Kuwait, KWT
| | - Ahmad Alrasheedi
- Otorhinolaryngology - Head and Neck Surgery, Farwaniya Hospital, Kuwait, KWT
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Alessandri-Bonetti M, Costantino A, Cottone G, Carbonaro R, Cardone F, Amendola F, De Virgilio A, Robotti E, Persichetti P, Vaienti L. Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta-analysis. Laryngoscope 2023; 133:3237-3246. [PMID: 37017244 DOI: 10.1002/lary.30684] [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: 09/27/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up. METHODS An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results. RESULTS A total of 2577 patients (males: 65.1%, 95% CI: 59.9-70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4-36.2) were included in this meta-analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3-71.9). The pooled MD in NOSE score at 6-months follow-up compared to baseline was -48.8 (n = 1730, 95% CI: -54.6 to -42.9). CONCLUSIONS Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score. LEVEL OF EVIDENCE NA Laryngoscope, 133:3237-3246, 2023.
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Affiliation(s)
- Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Giuseppe Cottone
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Riccardo Carbonaro
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Federica Cardone
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesco Amendola
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy
| | - Enrico Robotti
- Private Practice, Clinica Sant'Apollonia, Via Giovanni Motta, 37-24123, Bergamo, Italy
| | - Paolo Persichetti
- Department of Reconstructive and Aesthetic Plastic Surgery, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo, 200, Rome, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi, University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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10
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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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11
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Carrie S, O'Hara J, Fouweather T, Homer T, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 2023; 383:e075445. [PMID: 37852641 PMCID: PMC10583133 DOI: 10.1136/bmj-2023-075445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To assess the clinical effectiveness of septoplasty. DESIGN Multicentre, randomised controlled trial. SETTING 17 otolaryngology clinics in the UK's National Health Service. PARTICIPANTS 378 adults (≥18 years, 67% men) newly referred with symptoms of nasal obstruction associated with septal deviation and at least moderate symptoms of nasal obstruction (score >30 on the Nasal Obstruction and Symptom Evaluation (NOSE) scale). INTERVENTIONS Participants were randomised 1:1 to receive either septoplasty (n=188) or defined medical management (n=190, nasal steroid and saline spray for six months), stratified by baseline symptom severity and sex. MAIN OUTCOME MEASURES The primary outcome measure was patient reported score on the Sino-Nasal Outcome Test-22 (SNOT-22) at six months, with 9 points defined as the minimal clinically important difference. Secondary outcomes included quality of life and objective nasal airflow measures. RESULTS Mean SNOT-22 scores at six months were 19.9 (95% confidence interval 17.0 to 22.7) in the septoplasty arm (n=152, intention-to-treat population) and 39.5 (36.1 to 42.9) in the medical management arm (n=155); an estimated 20.0 points lower (better) for participants randomised to receive septoplasty (95% confidence interval 16.4 to 23.6, P<0.001, adjusted for baseline continuous SNOT-22 score and the stratification variables sex and baseline NOSE severity categories). Greater improvement in SNOT-22 scores was predicted by higher baseline symptom severity scores. Quality of life outcomes and nasal airflow measures (including peak nasal inspiratory flow and absolute inhalational nasal partitioning ratio) improved more in participants in the septoplasty group. Readmission to hospital with bleeding after septoplasty occurred in seven participants (4% of 174 who had septoplasty), and a further 20 participants (12%) required antibiotics for infections. CONCLUSIONS Septoplasty is a more effective intervention than a defined medical management regimen with a nasal steroid and saline spray in adults with nasal obstruction associated with a deviated nasal septum. TRIAL REGISTRATION ISRCTN Registry ISRCTN16168569.
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Affiliation(s)
- Sean Carrie
- Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
| | - James O'Hara
- Department of Ear, Nose and Throat, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Medical School, Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Northern Ireland Clinical Trials, Belfast, Northern Ireland, UK
| | | | - Naveed Kara
- Department of Ear, Nose and Throat, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Department of Ear, Nose and Throat, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel C Leong
- Department of Ear, Nose and Throat, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Department of Ear, Nose and Throat, NHS Grampian, Aberdeen, UK
| | - Jillian Morrison
- General Practice and primary Care, University of Glasgow, Glasgow, UK
| | - Paul Nix
- Department of Ear, Nose and Throat, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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12
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Merma-Linares C, Martinez MD, Gonzalez M, Alobid I, Figuerola E, Mullol J. Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria. Curr Allergy Asthma Rep 2023; 23:567-578. [PMID: 37561310 PMCID: PMC10506933 DOI: 10.1007/s11882-023-01104-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient's quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP). RECENT FINDINGS A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP). Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.
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Affiliation(s)
- Carla Merma-Linares
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain.
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
- Universitat Rovira i Virgili, Tarragona, Spain.
| | - M Dolores Martinez
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Miriam Gonzalez
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Isam Alobid
- Skull Base Unit, ENT department, Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
| | - Enric Figuerola
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
- Universitat de Barcelona, Barcelona, Spain.
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13
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Karataş M, Koparal M, Yılmazer C, Kelles M. Correlations between objective and subjective tests of nasal patency in patients undergoing septoplasty. J Laryngol Otol 2023; 137:413-418. [PMID: 35607263 DOI: 10.1017/s002221512200127x] [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: 11/06/2022]
Abstract
OBJECTIVE This study assessed correlations between pre- and post-operative objective and subjective nasal patency test results in patients undergoing septoplasty to treat nasal septum deviation. METHOD Eighty nasal septum deviation patients who underwent septoplasty were prospectively enrolled. Nasal Obstruction Symptom Evaluation questionnaire scores, anterior rhinomanometry and acoustic rhinometry data were compared pre-operatively and three months after surgery. The left, right and total volume and left, right and total minimum cross-sectional area acoustic rhinometry values were compared. RESULTS The left volume, total volume, left minimum cross-sectional area and total minimum cross-sectional area differed significantly between the two time-points (all p < 0.05). The total resistance, inspiratory total airflow, expiratory total resistance and expiratory total airflow rhinomanometric data did not differ between the two timepoints (all p > 0.05). CONCLUSION This study suggested that subjective tests such as the Nasal Obstruction Symptom Evaluation questionnaire are optimal to identify complaints and assess post-operative satisfaction.
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Affiliation(s)
- M Karataş
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Koparal
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - C Yılmazer
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Kelles
- Department of Otolaryngology, Faculty of Medicine, Turgut Özal University, Malatya, Turkey
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14
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Mnatsakanyan AG, Korolev AG, Tsymbal AA, Inozemtsev AN, Bankurova TI, Shilin SS, Emets YI, Amirkhanyan SS, Kuznetsov ND, Glukhova AI, Vasyakova SM, Gusev KS, Ganshin IB, Drozdova GA. Comparison of the Effect on Heart Rate Variability for Modeling Septoplasty and Modeling Deprivation of the Olfactory Analyzer in Rats. DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2023; 509:107-111. [PMID: 37208576 DOI: 10.1134/s0012496623700291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 05/21/2023]
Abstract
Modeling septoplasty and modeling sensory deprivation of the olfactory analyzer in rats were compared for the effect on the frequency domain of heart rate variability (HRV). Bulbectomy provoked more pronounced changes in HRV as compared with septoplasty simulation.
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Affiliation(s)
| | - A G Korolev
- Peoples' Friendship University of Russia, Moscow, Russia
- Moscow State University, Moscow, Russia
| | - A A Tsymbal
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - T I Bankurova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - S S Shilin
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Ya I Emets
- Peoples' Friendship University of Russia, Moscow, Russia
| | | | - N D Kuznetsov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A I Glukhova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - S M Vasyakova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - K S Gusev
- Peoples' Friendship University of Russia, Moscow, Russia
| | - I B Ganshin
- Peoples' Friendship University of Russia, Moscow, Russia
| | - G A Drozdova
- Peoples' Friendship University of Russia, Moscow, Russia
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15
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Sunnergren O, Pakpour AH, Bergquist H, Sahlstrand‐Johnson P, Stjärne P, Broström A. Validation and psychometric evaluation of the Swedish version of the
Nasal Obstruction Symptom Evaluation
scale. Laryngoscope Investig Otolaryngol 2023; 8:357-366. [PMID: 37090889 PMCID: PMC10116965 DOI: 10.1002/lio2.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific quality-of-life questionnaire for patients suffering from nasal obstruction. The instrument is designed specifically for patients with septal deviation and for the evaluation of the outcome of septoplasty. The aim of this study was to validate a Swedish version of the NOSE instrument for use in clinical practice and research. Methods A Swedish version of the NOSE was tested in a case group consisting of 125 subjects with nasal obstruction (of which 31 underwent septoplasty) and a control group consisting of 65 healthy subjects. Base line data for the case and control groups were used to evaluate face validity, known groups validity, construct validity, internal consistency and factor structure analysis. Fifty participants in both the case groups and control groups were assessed both at baseline and after 2 weeks to evaluate test-retest reliability. The participants who underwent septoplasty were assessed at baseline and after 3-6 months to evaluate responsiveness. Results The S-NOSE was found to be reliable, valid, and responsive. Both Cronbach's α and McDonald Omega coefficients were >0.7, and the intra class coefficient was 0.942. The S-NOSE scores were significantly correlated with nasal patency VAS in both the case group and the control group (p < .001 and p = .018, respectively). After septoplasty, the mean S-NOSE score were significantly improved (p < .001). Furthermore, the S-NOSE was shown to have excellent and robust psychometric properties. Conclusion The S-NOSE can be recommended in both clinical practice and research to evaluate the outcome of septoplasty in Swedish-speaking populations. Level of Evidence NA.
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Affiliation(s)
- Ola Sunnergren
- Ear, Nose & Throat Clinic Region Jönköping County Jönköping Sweden
| | - Amir H. Pakpour
- Department of Nursing, School of Health and Welfare Jönköping University Jönköping Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery Sahlgrenska University Hospital Gothenburg Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | | | - Pär Stjärne
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Sciences, Intervention and Technology Division of Otorhinolaryngology, Karolinska Institute Stockholm Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare Jönköping University Jönköping Sweden
- A.D.U.L.T., School of Health and Welfare Jönköping University Jönköping Sweden
- Department of Clinical Neurophysiology University Hospital Linköping Linköping Sweden
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Vestlandet Norway
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16
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Youn GM, Shah JP, Wei EX, Kandathil C, Most SP. Revision Rates of Septoplasty in the United States. Facial Plast Surg Aesthet Med 2023; 25:153-158. [PMID: 35394347 PMCID: PMC9986010 DOI: 10.1089/fpsam.2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Large-scale studies characterizing septoplasty revision rates are lacking. Objectives: To identify rates of septoplasty revision in the United States. Methods: Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM® MarketScan® Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery. Results: 295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds. Conclusion: Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.
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Affiliation(s)
- Gun Min Youn
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jay P. Shah
- Stanford University School of Medicine, Stanford, California, USA
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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17
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Pandrangi VC, Mace JC, Kim JH, Geltzeiler M, Detwiller KY, Soler ZM, Schlosser RJ, Alt JA, Ramakrishnan VR, Mattos JL, Smith TL. Work productivity and activity impairment in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery-A prospective, multi-institutional study. Int Forum Allergy Rhinol 2023; 13:216-229. [PMID: 35938699 PMCID: PMC9905326 DOI: 10.1002/alr.23070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Productivity loss and activity limitations due to chronic rhinosinusitis (CRS) are known to contribute to the significant economic and personal burden of disease. The purpose of this study was to assess productivity and activity impairment before and after endoscopic sinus surgery (ESS) for medically refractory CRS. METHODS This investigation was a prospective, multi-institutional, observational cohort study. Patients diagnosed with medically refractory CRS completed the Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP) questionnaire before surgery and approximately 6 months after the procedure. Factors associated with minimal clinical important differences (MCIDs) for productivity and activity impairment were identified. RESULTS A total of 279 study participants were screened for inclusion, of whom 176 (63.1%) with postoperative follow-up were included in the final cohort. Preoperative productivity and activity impairment were observed in 63.2% and 69.8% of the patients, respectively. Among these patients, postoperative improvement equaling at least 1 MCID was reported in both productivity (76.1%) and activity (76.4%) impairments. Multivariate regression identified sphenoidotomy (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.03-17.02) as the only factor associated with increased likelihood of productivity improvement, whereas septoplasty during ESS (OR, 8.45; 95% CI, 2.33-30.68) and migraine (OR, 0.35; 95% CI, 0.12-0.96) were associated with differential odds of activity improvement. CONCLUSION CRS is associated with a substantial burden on productivity and activity that significantly improves after treatment with ESS. These data may facilitate improved patient counseling and shared decision-making regarding surgical management for CRS.
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Affiliation(s)
- Vivek C Pandrangi
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
| | - Jee-Hong Kim
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
| | - Mathew Geltzeiler
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
| | - Kara Y Detwiller
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jeremiah A Alt
- Division of Rhinology and Sinus Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Vijay R Ramakrishnan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Indiana, Indianapolis, IN
| | - Jose L Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health & Science University, Portland, OR
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18
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Shin GC, Kang JW, Park JH, Lee HC, Kim KS. Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty. Yonsei Med J 2023; 64:42-47. [PMID: 36579378 PMCID: PMC9826964 DOI: 10.3349/ymj.2022.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Septoturbinoplasty is frequently performed to correct nasal obstruction; however, there is still a lack of research on changes in nasal and nose-related symptoms early after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes within 6 months after septoturbinoplasty. MATERIALS AND METHODS The medical records of patients who underwent septoturbinoplasty at Gangnam Severance Hospital were retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test (SNOT-22) and obstruction scores. The SNOT-22 and obstruction scores were investigated before surgery and at 1, 3, and 6 months after surgery. RESULTS We noted significant decreases in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before surgery (p<0.001). However, there were no significant changes at 3 and 6 months after surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after surgery was significantly associated with a significant improvement in symptoms at 3 or 6 months after septoturbinoplasty (p=0.029). CONCLUSION These results imply that subjective outcomes and degree of improvement in the first month after septoturbinoplasty can be used as a predictor of the results thereof and for counseling patients about its progress.
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Affiliation(s)
- Geun Cheol Shin
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Ha Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Cheol Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Hellgren J, Lundberg M, Rubek N, von Buchwald C, Steinsvåg S, Mäkitie A. Unmet challenges in septoplasty–nordic studies from a uniform healthcare and geographical area. Front Surg 2022; 9:1061440. [DOI: 10.3389/fsurg.2022.1061440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
PurposeNasal septoplasty is one of the most common surgical procedures in otorhinolaryngology and optimising both patient selection and the surgery is a challenge. The Nordic countries have similar public healthcare systems and comparable populations in terms of size.MethodsThis is a review of studies of outcome and predictors related to septoplasty from Denmark, Finland, Norway and Sweden, published during the last decade. The aim of this review was to identify areas in need of further research to meet the challenges of septoplasty in the Nordic countries with reference to international data.ResultsPostoperative patient satisfaction at 6–12 months was reported in around 2/3 of the patients and well in line with international data. Patients with more severe symptoms had a higher chance of improvement. Lack of standardisation in patient selection, surgical methods and skills, and follow up procedures, still makes it difficult to explain the 25% failure rate in septoplasty surgery.ConclusionThis review of the Nordic studies from the last decade shows that septoplasty in general is effective in relieving nasal obstruction. There is a need for studies addressing the standardisation of diagnostic tools and algorithms and the systematic and continuous implementation of follow-up of the surgical results at both departmental and personal level. This includes an awareness of how surgical skills in septoplasty are obtained and maintained.
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Bin Lajdam G, Alaryani K, Ghaddaf AA, Aljabri A, Halawani A, Alshareef M, Algarni M, Al-Hakami H. Septoplasty versus septoplasty with turbinate reduction for nasal obstruction due to deviated nasal septum: a systematic review and meta-analysis. Rhinology 2022; 60:411-420. [PMID: 36150153 DOI: 10.4193/rhin22.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Compensatory inferior turbinate hypertrophy is a common accompanying manifestation in patients with nasal obstruction due to deviated nasal septum (DNS). The grounds for inferior turbinate reduction (ITR) in this population are still not well established. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of septoplasty with ITR versus septoplasty alone. METHODS Computerised search in Medline, Embase, and CENTRAL was performed. Eligible for inclusion were randomised controlled trials (RCTs) comparing septoplasty to septoplasty with unilateral, contralateral, ITR in adults with DNS. Primary outcomes were health-related quality of life and nasal patency. The secondary outcome was the occurrence of adverse events. Standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS Twelve RCTs that enrolled 775 participants were found eligible. Data were reported at follow-up periods ranging from 1 month to 48 months. The pooled effect estimate showed a statistically significant improvement with unilateral, contralateral, ITR in Nasal Obstruction Symptom Evaluation scale (NOSE) scores. The rate of adverse events was significantly higher with ITR. CONCLUSIONS Unilateral reduction of the hypertrophied contralateral inferior turbinate during septoplasty resulted in better subjective relief of nasal obstruction in adults with DNS than septoplasty alone. However, caution is warranted since only few well-designed RCTs were identified.
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Affiliation(s)
- G Bin Lajdam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - K Alaryani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Aljabri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Halawani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - M Alshareef
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - M Algarni
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Al-Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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21
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Reply to "Anxiety and depression in patients with nasal septal deviation: What is the clinical impact?". Am J Otolaryngol 2022; 43:103633. [PMID: 36095889 DOI: 10.1016/j.amjoto.2022.103633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
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Schmidt N, Behrbohm H, Goubergrits L, Hildebrandt T, Brüning J. Comparison of rhinomanometric and computational fluid dynamic assessment of nasal resistance with respect to measurement accuracy. Int J Comput Assist Radiol Surg 2022; 17:1519-1529. [PMID: 35821562 DOI: 10.1007/s11548-022-02699-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Computational fluid dynamics (CFD)-based calculation of intranasal airflow became an important method in rhinologic research. Current evidence shows weak to moderate correlation as well as a systematic underprediction of nasal resistance by numerical simulations. In this study, we investigate whether these differences can be explained by measurement uncertainties caused by rhinomanometric devices and procedures. Furthermore, preliminary findings regarding the impact of tissue movements are reported. METHODS A retrospective sample of 17 patients, who reported impaired nasal breathing and for which rhinomanometric (RMM) measurements using two different devices as well as computed tomography scans were available, was investigated in this study. Three patients also exhibited a marked collapse of the nasal valve. Agreement between both rhinomanometric measurements as well as between rhinomanometry and CFD-based calculations was assessed using linear correlation and Bland-Altman analyses. These analyses were performed for the volume flow rates measured at trans-nasal pressure differences of 75 and 150 Pa during inspiration and expiration. RESULTS The correlation between volume flow rates measured using both RMM devices was good (R2 > 0.72 for all breathing states), and no relevant differences in measured flow rates was observed (21.6 ml/s and 14.8 ml/s for 75 and 150 Pa, respectively). In contrast, correlation between RMM and CFD was poor (R2 < 0.5) and CFD systematically overpredicted RMM-based flow rate measurements (231.8 ml/s and 328.3 ml/s). No differences between patients with and without nasal valve collapse nor between inspiration and expiration were observed. CONCLUSION Biases introduced during RMM measurements, by either the chosen device, the operator or other aspects as for example the nasal cycle, are not strong enough to explain the gross differences commonly reported between RMM- and CFD-based measurement of nasal resistance. Additionally, tissue movement during breathing is most likely also no sufficient explanation for these differences.
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Affiliation(s)
- Nora Schmidt
- Department of Otorhinolaryngology and Facial Plastic Surgery, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany.
| | - Hans Behrbohm
- Department of Otorhinolaryngology and Facial Plastic Surgery, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Hildebrandt
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Brüning
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Ho YT, Lee TJ, Fu CH. Association between Clinical Factors and Surgical Outcomes for Patients with Persistent Allergic Rhinitis. EAR, NOSE & THROAT JOURNAL 2022:1455613221091098. [PMID: 35440219 DOI: 10.1177/01455613221091098] [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: 11/15/2022] Open
Abstract
Objective: While septoplasty with turbinoplasty is commonly performed for patients with nasal obstruction, no study has addressed its efficacy and related determinants in patients with allergic rhinitis (AR) and various symptoms. This study aimed to identify potential factors associated with surgical outcomes in patients with persistent AR (PAR) who underwent septoplasty with turbinoplasty. Methods: We prospectively recruited patients with PAR and positive allergy test results for surgical treatment. We also collected relevant preoperative laboratory data. The Sinonasal Outcome Test-22 (SNOT-22) survey was administered to all patients one day before and one year after surgery. Results: A total of 128 patients who completed a one-year postoperative follow-up were enrolled. The total SNOT-22 score and five subdomain scores significantly improved postoperatively. We found that women and those with higher preoperative SNOT-22 scores experienced more postoperative improvement and had a greater potential to reach minimal clinically important differences (MCID). A preoperative SNOT-22 score greater than the determined cut-off value of 42.5 had an approximately 6-fold likelihood of MCID achievement. Patients in the nasal obstruction group and non-smokers demonstrated greater postoperative improvement in the sleep subdomain. Conclusions: Women with PAR and those with a preoperative SNOT-22 score above 42.5 were preferable candidates for surgery and expressed greater satisfaction. Notably, rhinologic presentations and non-rhinologic symptoms of PAR patients could benefit from within one year after surgery. Here, we discuss the factors associated with subjective surgical outcomes to help physicians and patients with AR in preoperative consultations.
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Affiliation(s)
- Yan-Ting Ho
- Department of Otolaryngology, Head and Neck Surgery, 38014Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Department of Otolaryngology, Head and Neck Surgery, 38014Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Department of Otolaryngology, Head and Neck Surgery, 38014Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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24
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Rovers MM, Wijn SRW, Grutters JPC, Metsemakers SJJPM, Vermeulen RJ, van der Pennen R, Berden BJJM, Gooszen HG, Scholte M, Govers TM. Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands. BMJ Open 2022; 12:e054110. [PMID: 35396284 PMCID: PMC8995574 DOI: 10.1136/bmjopen-2021-054110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost. DESIGN We developed decision analytical models to estimate the consequences of delayed elective surgical procedures (eg, total hip replacement, bariatric surgery or septoplasty). SETTING The framework was applied to a large hospital in the Netherlands. OUTCOME MEASURES Quality measures impacts on quality of life and costs were taken into account and combined to calculate net monetary losses per week delay, which quantifies the total loss for society expressed in monetary terms. Net monetary losses were weighted by operating times. RESULTS We studied 13 common elective procedures from four specialties. Highest loss in quality of life due to delayed surgery was found for total hip replacement (utility loss of 0.27, ie, 99 days lost in perfect health); the lowest for arthroscopic partial meniscectomy (utility loss of 0.05, ie, 18 days lost in perfect health). Costs of surgical delay per patient were highest for bariatric surgery (€31/pp per week) and lowest for arthroscopic partial meniscectomy (-€2/pp per week). Weighted by operating room (OR) time bariatric surgery provides most value (€1.19/pp per OR minute) and arthroscopic partial meniscectomy provides the least value (€0.34/pp per OR minute). In a large hospital the net monetary loss due to prolonged waiting times was €700 840 after the first COVID-19 wave, an increase of 506% compared with the year before. CONCLUSIONS This surgical prioritisation framework can be tailored to specific centres and countries to support priority setting for delayed elective operations during and after the COVID-19 pandemic, both in and between surgical disciplines. In the long-term, the framework can contribute to the efficient distribution of OR time and will therefore add to the discussion on appropriate use of healthcare budgets. The online framework can be accessed via: https://stanwijn.shinyapps.io/priORitize/.
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Affiliation(s)
- Maroeska M Rovers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Stan RW Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Janneke PC Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Sanne JJPM Metsemakers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Robin J Vermeulen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Ron van der Pennen
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Bart JJM Berden
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
- IQ healthcare, Radboud Insititute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Mirre Scholte
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
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Septoplasty: Early (first year) and late (fourth year) postoperative results in 604 patients. The Journal of Laryngology & Otology 2021; 136:514-519. [PMID: 34823616 DOI: 10.1017/s0022215121003741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Bruehlmann C, Buser N, Soyka M. Mouth breathing – A predictor for patient satisfaction after nasal septoplasty? RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: No reliable marker exists to predict septoplasty outcome. Most patients suffering from nasal airway obstruction (NAO) caused by a deviation of the nasal septum report a bothersome mouth breathing and dryness. In this study our aim was to assess, whether mouth breathing could be objectified in these patients and whether mouth breathing could predict septoplasty outcome. Methods: A monocentric, prospective case-control study of 21 patients was conducted. The proportion of mouth breathing was measured in a blinded manner. As a measurement of patient satisfaction, subjective symptoms pre- and postoperatively, were assessed by using VAS, NOSE and SNOT-20 score. In the patient group an additional acoustic rhinometry and a clinical examination of the nose were performed. Results: With a mean of 25% (SD = 20%) the proportion of mouth breathing in patients with NAO did not differ significantly from the proportion in controls without NAO, with a mean of 27% (SD = 23%). Analysis of subjective scores revealed a significant reduction of subjective symptoms after septoplasty. A higher preoperative proportion of mouth breathing correlated with more remaining postoperative NAO. Conclusions: The percentage of mouth breathing is no different in patients with symptomatic septal deviation than in control patients. Mouth breathing in patients with NAO, evaluated for septoplasty, could be a negative predictive factor for patient satisfaction after nasal septoplasty. Mouth breathing in these patients should be observed carefully because more preoperative mouth breathing should make one more hesitant to consider septoplasty.
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Feng D, Yang Y, Liu J, Ke X, Shen Y, Zhang Y, Huang J. Short report: nasal obstruction recovery after septoplasty in patients with nasal septal deviation affected by anxiety and depression. PSYCHOL HEALTH MED 2021; 27:1627-1636. [PMID: 34749562 DOI: 10.1080/13548506.2021.2002378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This research was aimed to explore whether the recovery of subjective symptoms and objective examination in nasal septum deviation (NSD) patients after septoplasty were related to the degree of preoperative anxiety or depression, in the hope of providing new ideas for clinical treatment. A total of 150 NSD patients were included in this prospective research. Visual analogue scale (VAS) scores, Nasal Obstruction Symptom Evaluation (NOSE) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, total inspiratory and expiratory nasal resistance were recorded before and 6 months after operation. The results showed preoperative anxiety or depression was not statistically different between groups in terms of age, gender and course, but positively correlated with nasal obstruction (VAS and NOSE). The recovery of nasal obstruction in patients with anxiety or depression was worse than that in normal NSD patients 6 months after surgery, and was decreased with the increase of anxiety or depression degree. And no significant difference showed in the reduction of total inspiratory and expiratory nasal resistance between groups. In conclusion, anxiety and depression affected the improvement of nasal obstruction feeling in NSD patients after septoplasty, and the improvement was negatively correlated with the degree of anxiety and depression. It is necessary to evaluate the anxiety and depression of NSD patients before septoplasty.
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Affiliation(s)
- Dandan Feng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yucheng Yang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Liu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xia Ke
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Shen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangju Huang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Does turbinate reduction combined with septoplasty have better outcomes than septoplasty alone? A randomised controlled study. The Journal of Laryngology & Otology 2021; 136:55-59. [PMID: 34702382 DOI: 10.1017/s0022215121003340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dreyfuss M, Cohen-Vaizer M, Rokade A, Laske RD. Cost-Effectiveness of Septorhinoplasty. Facial Plast Surg Aesthet Med 2021; 24:215-220. [PMID: 34647820 DOI: 10.1089/fpsam.2021.0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Septorhinoplasties are performed for functional, aesthetic, or a combination of these indications. As a nonvital intervention, cost-effectiveness may be questioned. Objective: To determine the cost-effectiveness of septorhinoplasty. Design and Setting: The literature was reviewed for revision rates (RRs) and health utility values (HUVs) for both septorhinoplasty and revision septorhinoplasty. Age-specific mortality rates and life expectancies were used. Costs were gathered from international settings and analyzed in an adapted Markov model. Intervention: Septorhinoplasty versus no intervention. Main Outcomes and Measures: Cost-efficiency was calculated for different willingness-to-pay thresholds in a probabilistic sensitivity analysis. The effect of different parameters (costs, RRs, HUVs, age, gender) were reviewed and addressed in a sensitivity analysis for an incremental cost-effectiveness ratio (ICER) willingness-to-pay threshold of $50,000/quality-adjusted life year (QALY). Results: The ICER for septorhinoplasty for a 40-year-old woman ranges from $1216 to $3509/QALY (depending on the country) in comparison with no intervention. Septorhinoplasty is cost-effective in 98.8% (for a $50,000/QALY threshold). The sensitivity analysis showed high robustness of the cost-effectiveness for various scenarios. Conclusions and Relevance: Septorhinoplasty is a highly cost-effective treatment.
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Affiliation(s)
- Michael Dreyfuss
- Department of Industrial Engineering and Management, Jerusalem College of Technology, Jerusalem, Israel
| | - Mauricio Cohen-Vaizer
- Department of Otolaryngology, Head and Neck Surgery, Rambam Health Care Center, Haifa, Israel
| | - Ashok Rokade
- ENT Department, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Roman D Laske
- Department of Otolaryngology, Head and Neck Surgery, HNO Wiedikon, ENT, Zurich, Switzerland.,Department of Otolaryngology, Head and Neck Surgery, See-Spital Kilchberg, Kilchberg, Switzerland
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Harju T, Numminen J. The Long-term Effect of Inferior Turbinate Surgery Techniques on Nasal Obstruction and Quality of Life. Ann Otol Rhinol Laryngol 2021; 131:933-940. [PMID: 34612723 PMCID: PMC9340137 DOI: 10.1177/00034894211049573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the study was to compare the long-term effects of radiofrequency ablation (RFA), microdebrider-assisted inferior turbinoplasty (MAIT), and diode laser techniques on the severity of nasal obstruction and quality of life (QOL) in a 3-year follow-up. METHODS The patients filled a Visual Analog Scale (VAS) regarding the severity of nasal obstruction and the Glasgow Health Status Inventory (GHSI) questionnaire preoperatively and during the control visits at 3 months and 3 years. Acoustic rhinometry was also performed. A total of 78 patients attended both control visits. RESULTS All 3 techniques improved the VAS score for the severity of nasal obstruction and the GHSI total score significantly compared to the preoperative values at both 3 months and 3 years. Compared to the preoperative values, all 3 techniques increased the V2 to 5 cm values significantly at 3 months. After 3 years, compared to the preoperative values, the MAIT (P = .005) and diode laser (P < .001) still had a statistically significant volume increase in V2 to 5 cm, whereas the RFA (P = .06) did not achieve a statistically significant effect. CONCLUSION The RFA, MAIT, and diode laser all improved both the patients' subjective sensation of the severity of nasal obstruction and QOL significantly. The response was sustained during the 3-year follow-up period with all 3 techniques. A weakening in the objective treatment response to RFA was found in the longer follow-up, but that did not cause a weakening of the patients' subjective treatment response.
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Affiliation(s)
- Teemu Harju
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Pirkanmaa, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Pirkanmaa, Finland
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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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Liu J, Qian Z, Yan Z, Yang X, Wang N. Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery. Eur Arch Otorhinolaryngol 2021; 279:2423-2431. [PMID: 34302496 DOI: 10.1007/s00405-021-07012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD). METHODS The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed. RESULTS The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05). CONCLUSION The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.
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Affiliation(s)
- Jinfeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Zhuoming Qian
- Department of Otorhinolaryngology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, 101400, China
| | - Zhanfeng Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.,Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xuwen Yang
- 7 Medical Students of Long Schooling Class 3, The Third Clinical Medical School, Capital Medical University, Beijing, 100020, China
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
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Kastyro IV, Popadyuk VI, Reshetov IV, Kostyaeva MG, Dragunova SG, Kosyreva TF, Khamidulin GV, Shmaevsky PE. Changes in the Time-Domain of Heart Rate Variability and Corticosterone after Surgical Trauma to the Nasal Septum in Rats. DOKL BIOCHEM BIOPHYS 2021; 499:247-250. [PMID: 34426921 DOI: 10.1134/s1607672921040098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/22/2022]
Abstract
The aim of the work was to study changes in the time range of heart rate variability (HRV) against the background of changes in the concentration of corticosterone in blood plasma in rats after surgical trauma to the nasal septum. Septoplasty was simulated in 30 mature male Wistar rats weighing 210-290 g. ECG was recorded with subsequent analysis of the time domain of HRV, as well as blood sampling to estimate changes in the concentration of corticosterone in the blood plasma was performed. As a result, SDNN significantly increased in comparison with the control on days 2 and 3 (p < 0.001) but decreased on days 4-5 (p < 0.001) and 6 (p < 0.01). rMSSD changed in waves with two irregular peaks on days 1 and 6. SDNN/rMSSD, in comparison with the 1st day of the postoperative period, increased on the 2nd day, continued to increase (p < 0.05), and then began to decrease on day 4 (p < 0.01). The total HRV power of was low throughout the postoperative period (p < 0.001), except for day 3, when it was equal to the control data. The increase in the total power index fell on day 3 after the operation (p <0.01), after which its decline was observed again. The concentration of corticosterone in the blood plasma in rats was significantly higher than before (p < 0.001). On postoperative day 2 to 4, its plateau was determined. Simulation of septoplasty leads to changes in the time range of HRV, an increase in the concentration of corticosterone in the blood plasma in rats with its maximum at the time of surgery and 24 h later, and the formation of a "plateau" on postoperative days 2 to 4, which coincides with the changes in HRV.
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Affiliation(s)
- I V Kastyro
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
| | - V I Popadyuk
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - I V Reshetov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M G Kostyaeva
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - S G Dragunova
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - T F Kosyreva
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - G V Khamidulin
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - P E Shmaevsky
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
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Kimura S, Suzuki M, Honma A, Nakazono A, Osawa M, Nakamaru Y, Homma A. Objective evaluation of caudal deviation of the nasal septum and selection of the appropriate septoplasty technique. Auris Nasus Larynx 2021; 49:67-76. [PMID: 33966932 DOI: 10.1016/j.anl.2021.04.012] [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: 08/27/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Several methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans. METHODS We retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the "Anterior-posterior Position of the most deviated point of the nasal septum (AP)," which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined. RESULTS The AP was significantly correlated with the VAS score (r=-0.58, p=0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14±0.06 to 0.03±0.03, p=0.004), but not by KI (0.09±0.08 to 0.04±0.03, p=0.25). OSR also improved nasal airway resistance (1.10±0.44 to 0.42±0.15, p=0.02), and the VAS score (79.11±14.74 to 5.78±7.89, p=0.004). CONCLUSION Nasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique.
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Affiliation(s)
- Shogo Kimura
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masanobu Suzuki
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Aya Honma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akira Nakazono
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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Treatment success after rhinosurgery: an evaluation of subjective and objective parameters. Eur Arch Otorhinolaryngol 2021; 279:205-211. [PMID: 33813628 PMCID: PMC8738622 DOI: 10.1007/s00405-021-06787-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
Purpose Septal deviation and nose deformities are widely prevalent. As a consequence, patients may complain about difficulties in nasal breathing leading to a perception of diminished disease-specific quality of life. In a prospective randomized trial, we aimed to analyse the outcome of septoplasty (SPL) and septorhinoplasty (SRP) on patient satisfaction. Methods Patients with functional indication for SPL (n = 19) or SRP (n = 54) were included and randomized for additional turbinoplasty. Preoperative clinical symptoms were collected with SNOT-20 GAV (Sinu-nasal outcome test-20—German adapted version) and NOSE© (nasal obstruction symptom evaluation) questionnaires. The final evaluation of treatment success was performed 9 months after surgery with SNOT-20 GAV, NOSE© and a self-established feedback questionnaire. Nasal breathing and obstruction were objectively measured with rhinomanometry and acoustic rhinometry [minimum cross-sectional area 2 (MCA2)]. Results Minimum cross-sectional area 2 was statistically improved compared to the pre-treatment value in SPL (p = 0.0004) and SRP (p = 0.0001). Regarding MCA2 values of matched patient groups, similar findings were detected (SPL: p = 0.0013, SRP: p < 0.0001). Sinu-nasal outcome test-20 GAV and NOSE© scores were significantly reduced after both surgical procedures (NOSE©: SPL: p < 0.0001, SRP: p < 0.0001; SNOT-20 GAV: SPL: p = 0.0068, SRP: p < 0.0001). Evaluation of patient satisfaction in a self-established feedback questionnaire revealed a motivation of 81% of patients to redo the surgery (SPL 13/16, SRP 34/42) and a notably general satisfaction of 86% for SPL and 80% for SRP. Conclusion Rhinosurgery leads to quantitative better nasal breathing and increased disease-specific satisfaction. However, this study implies the importance of the right selection of patients and the correct indication of the surgical technique.
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36
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Grose EM, Holmes CP, Aravinthan KA, Wu V, Lee JM. Readability and quality assessment of internet-based patient education materials related to nasal septoplasty. J Otolaryngol Head Neck Surg 2021; 50:16. [PMID: 33731227 PMCID: PMC7970817 DOI: 10.1186/s40463-021-00507-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/05/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Given that nasal septoplasty is a common procedure in otolaryngology - head and neck surgery, the objective of this study was to evaluate the quality and readability of online patient education materials on septoplasty. METHODS A Google search was performed using eight different search terms related to septoplasty. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index. The DISCERN tool was used to assess quality and reliability. RESULTS Eighty-five online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 54.9 ± 11.5, indicating they were fairly difficult to read. The average reading grade level was 10.5 ± 2.0, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 42.9 ± 10.5 and 42% (36/85) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. CONCLUSION The majority of online patient education materials on septoplasty are written above the recommended reading levels and have significant deficiencies in terms of their quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients' decision making.
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Affiliation(s)
- Elysia M Grose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Connor P Holmes
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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37
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Unadkat SN, Pendolino AL, Auer D, Khwaja S, Randhawa PS, Andrews PJ, Saleh HA. The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19. Facial Plast Surg 2021; 37:625-631. [PMID: 33676375 DOI: 10.1055/s-0041-1725162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.
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Affiliation(s)
- Samit N Unadkat
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Alfonso Luca Pendolino
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Deborah Auer
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
| | - Sadie Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Premjit S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Peter J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Hesham A Saleh
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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38
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Balai E, Jolly K, Bhamra N, Osborne MS, Barraclough J. The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics. Ann R Coll Surg Engl 2021; 103:291-295. [PMID: 33661043 DOI: 10.1308/rcsann.2020.7034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2011, septorhinoplasty and rhinoplasty were reclassified as procedures of limited clinical value in the NHS. The criteria for funding these operations varies across England. We used hospital episode statistics and freedom of information requests to review the total number of rhinology procedures performed across the previous decade, looking at trends in practice related to time, demographics and commissioning policy. MATERIALS AND METHODS Hospital episode statistics for 2012-2019 were used to calculate the number of septoplasty, septorhinoplasty, rhinoplasty and reduction rhinoplasty procedures performed in children and adults. Freedom of information requests were also made to all clinical commissioning groups in England asking for number of procedures performed and number of individual funding requests made. RESULTS A total of 158,031 procedures were performed over this period; the majority were in adult (99.0%) men (65.7%). Septoplasty was the most frequently performed operation; however, the total numbers declined by 5.4% over this period. There was a yearly reduction in the overall number of septorhinoplasty, rhinoplasty and reduction rhinoplasty operations. Four clinical commissioning groups provided a detailed breakdown of data by year and procedure. Those that required individual funding requests for all cases saw septorhinoplasty numbers fall by 81% and 75% over the period. Those that did not, saw numbers increase or remain the same. CONCLUSIONS We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.
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Affiliation(s)
- E Balai
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - K Jolly
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Bhamra
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M S Osborne
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - J Barraclough
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon. Eur Arch Otorhinolaryngol 2021; 278:3867-3875. [PMID: 33624151 PMCID: PMC8382632 DOI: 10.1007/s00405-021-06696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Background Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. Methods Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. Results The mean nose VAS for nasal obstruction (0–100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septoplasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. Conclusions In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty.
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40
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Grose E, Chiodo S, Levin M, Eskander A, Lin V, Hubbard B, Chiodo A. Patient Perspectives on Removing Adult Tonsillectomy and Septoplasty from the Government Health Insurance Plan in a Publicly Funded Health Care System. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211005193. [PMID: 33870750 PMCID: PMC8058792 DOI: 10.1177/00469580211005193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
In several publicly funded health care systems, including Ontario, Canada, adult tonsillectomies and septoplasties have been suggested to be removed or "delisted" from the government health insurance plan. Thus, the objective of this study was to explore patient perspectives regarding out of pocket (OOP) payment for these procedures. An anonymous survey was administered to patients consented to undergo a tonsillectomy or septoplasty at a community otolaryngology-head and neck surgery (OHNS) practice. The survey asked patients if they would pay the projected cost for their surgery OOP and the maximum amount of time they would wait for their surgery. The survey also contained questions on socioeconomic status and disease severity. Seventy-one patients were included. Overall, 21% of patients were willing to pay OOP for their surgery. Forty-nine percent of patients reported that the maximum amount of time they would be willing to wait for their surgery was 2 to 6 months. There was no significant correlation found between any of the demographic variables or disease severity and willingness to pay OOP for these surgeries. In this study, a small percentage of patients who met the clinical indications for a tonsillectomy or a septoplasty would pay for their surgery in the event that it was not covered by the government health insurance plan. These surgeries are common operations and delisting them could potentially decrease the provision of these services and have a significant impact on Canadian OHNS practices.
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Affiliation(s)
- Elysia Grose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Chiodo
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marc Levin
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, Michael Garron Hospital, The Toronto East Health Network, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brad Hubbard
- Department of Otolaryngology-Head & Neck Surgery, Michael Garron Hospital, The Toronto East Health Network, University of Toronto, Toronto, ON, Canada
| | - Albino Chiodo
- Department of Otolaryngology-Head & Neck Surgery, Michael Garron Hospital, The Toronto East Health Network, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Wang D, Liu T, Liao C, Tang G, Tian T, Tian L. Is nasal septal suturing an alternative technique to nasal packing?: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23535. [PMID: 33327302 PMCID: PMC7738143 DOI: 10.1097/md.0000000000023535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial. METHODS We will perform a systematic review of nasal packings effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed. RESULTS This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors. CONCLUSION This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty. OSF REGISTRATION NUMBER:: doi: 10.17605/OSF.IO/WF3GX.
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Affiliation(s)
- Dandan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Ting Liu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Chao Liao
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Guangjun Tang
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Tian Tian
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Li Tian
- Hospital of Chengdu University of Traditional Chinese Medicine
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Kang XR, Chen B, Chen YS, Yi B, Yan X, Jiang C, Wang S, Lu L, Shi R. A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study. PeerJ 2020; 8:e9890. [PMID: 32974101 PMCID: PMC7489239 DOI: 10.7717/peerj.9890] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background To create a nomogram prediction model for the efficacy of endoscopic nasal septoplasty, and the likelihood of patient benefiting from the operation. Methods A retrospective analysis of 155 patients with nasal septum deviation (NSD) was performed to develop a predictive model for the efficacy of endoscopic nasal septoplasty. Quality of life (QoL) data was collected before and after surgery using Sinonasal Outcome Test-22 (SNOT-22) scores to evaluate the surgical outcome. An effective surgical outcome was defined as a SNOT-22 score change ≥ 9 points after surgery. Multivariate logistic regression analysis was then used to establish a predictive model for the NSD treatment. The predictive quality and clinical utility of the predictive model were assessed by C-index, calibration plots, and decision curve analysis. Results The identified risk factors for inclusion in the predictive model were included. The model had a good predictive power, with a AUC of 0.920 in the training group and a C index of 0.911 in the overall sample. Decision curve analysis revealed that the prediction model had a good clinical applicability. Conclusions Our prediction model is efficient in predicting the efficacy of endoscopic surgery for NSD through evaluation of factors including: history of nasal surgery, preoperative SNOT-22 score, sinusitis, middle turbinate plasty, BMI, smoking, follow-up time, seasonal allergies, and advanced age. Therefore, it can be cost-effective for individualized preoperative assessment.
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Affiliation(s)
- Xue-Ran Kang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Bin Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Yi-Sheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Yi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Xiaojun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Chenyan Jiang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Shulun Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Lixing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Runjie Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai ninth people's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
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43
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Besser G, Liu DT, Renner B, Hummel T, Mueller CA. Reversible obstruction of the olfactory cleft: impact on olfactory perception and nasal patency. Int Forum Allergy Rhinol 2020; 10:713-718. [PMID: 32216168 PMCID: PMC7318610 DOI: 10.1002/alr.22549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Temporary disruption of sensory input can be studied relatively easily for vision or hearing by covering the eyes or ears. In contrast, closing the nostrils affects not only the sense of smell, but also the ability to breathe through the nose and humidify and warm inhaled air. We hypothesized that filling the olfactory cleft (OC) with dissolvable nasal dressing (foam) would temporarily block olfaction while respecting nasal airflow. METHODS In 30 healthy volunteers, the OC was unilaterally obstructed in a back-to-front fashion. Orthonasal and retronasal olfactory function were tested before and after foam application. Ratings of odors and subjective nasal patency (SNP) were collected. Peak nasal inspiratory flow (PNIF) was used to measure nasal patency. RESULTS Foam was safely applied in every case using minimal instruments. No complications were reported. Orthonasal and retronasal test results decreased significantly in overall participants (all p < 0.0008). Indicating temporary anosmia, 3 subjects reached the lowest possible score for odor-threshold testing, with corresponding drops in retronasal test scores. PNIF values before and after foam application were not significantly different (p = 0.11). SNP ratings decreased slightly, but not significantly (p = 0.052). Odor-intensity ratings dropped significantly (all p < 0.05). CONCLUSION The OC can be safely obstructed with dissolvable nasal dressing, resulting in a decrease in odor-intensity and orthonasal and retronasal olfactory function test scores. This procedure may serve as a hyposmia model that maintains normal nasal airflow.
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Affiliation(s)
- Gerold Besser
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - David T. Liu
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology and ToxicologyFriedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
- Institute of Clinical Pharmacology, Medizinische Fakultät Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of OtorhinolaryngologyTechnische Universität DresdenDresdenGermany
| | - Christian A. Mueller
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
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Kankaanpää A, Harju T, Numminen J. The Effect of Inferior Turbinate Surgery on Quality of Life: A Randomized, Placebo-Controlled Study. EAR, NOSE & THROAT JOURNAL 2020; 100:1107S-1112S. [PMID: 32453643 DOI: 10.1177/0145561320927944] [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] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this prospective, randomized, single-blinded, placebo-controlled study was to investigate the effects of radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) techniques on patients' quality of life (QOL) and to compare the techniques with a placebo procedure. METHODS A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into placebo, RFA, diode laser, and MAIT groups at a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. Quality of life was assessed with the Glasgow Health Status Inventory (GHSI). RESULTS The GHSI total score increased statistically significantly in all the groups, including placebo. There were no significant differences in the GHSI total score change between RFA, diode laser, and MAIT groups. The MAIT procedure improved the GHSI total score significantly more than the placebo procedure (P = .04). CONCLUSION All inferior turbinate surgery techniques lead to a significant improvement in the patients' QOL, and no significant differences were found between the techniques. The placebo treatment also improved the QOL significantly. Only the MAIT technique improved the QOL significantly more compared to placebo.
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Affiliation(s)
- Anna Kankaanpää
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Teemu Harju
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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45
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van Egmond MMHT, Grutters JPC, Hannink G, van Heerbeek N, Rovers MM. Septoplasty versus non-surgical management for nasal obstruction in adults with a deviated septum: economic evaluation alongside a randomized controlled trial. BMC Med 2020; 18:101. [PMID: 32354362 PMCID: PMC7193380 DOI: 10.1186/s12916-020-01562-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND For years, the benefits of septoplasty have been questioned. Due to the scarce and inconclusive literature, several National Health Service (NHS) Clinical Commissioning Groups in England decided to add septal surgery to their list of restricted procedures with low clinical value. Recently, evidence was obtained that septoplasty is actually more effective than non-surgical management for nasal obstruction in adults with a deviated septum. However, the relation between costs and effects of septoplasty remains unknown. METHODS We conducted an economic evaluation alongside an open, multicenter, pragmatic randomized controlled trial in two tertiary and 16 secondary referral hospitals in the Netherlands. Adults with nasal obstruction and a deviated septum were randomized to (1) septoplasty with or without concurrent turbinate surgery or (2) non-surgical management consisting of (a combination of) medical treatment and watchful waiting. Analyses were performed on an intention-to-treat basis. Single imputation nested in the bootstrap percentile method (using 5000 bootstrap replications) was performed to assess the effect of missing data. After 12 and 24 months, we assessed the incremental costs per quality-adjusted life year (QALY) gained from a healthcare and a societal perspective. RESULTS A total of 203 adults were randomly assigned to septoplasty (N = 102) or non-surgical management (N = 101). After 12 months, the mean cost difference between septoplasty and non-surgical management using a healthcare or societal perspective was €1181 (95%CI €1038 to €1323) or €2192 per patient (95%CI €1714 to €2670), respectively. The mean QALY difference was 0.03 per patient (95%CI - 0.01 to 0.07). Incremental costs per QALY gained from a healthcare or societal perspective were €41,763 or €77,525, respectively. After 24 months, the mean cost difference between the two groups using a healthcare or societal perspective decreased to €936 (95%CI €719 to €1153) or €1671 per patient (95%CI €952 to €2390), respectively. The mean QALY difference increased to 0.05 per patient (95%CI - 0.03 to 0.14). Incremental costs per QALY gained from a healthcare or societal perspective became €17,374 or €31,024, respectively. Analyses of imputed data did not alter our findings. CONCLUSIONS Depending on the selected perspective, cost-effectiveness threshold, and time horizon, septoplasty has the potential to be cost-effective. Despite considerable uncertainty, septoplasty seems to be cost-effective from a healthcare perspective, after 24 months against a threshold of €20,000 per QALY. From a societal perspective, septoplasty is not yet cost-effective after 24 months, but it comes closer to the cost-effectiveness threshold as time passes by. TRIAL REGISTRATION Nederlands Trial Register, NTR3868 (https://www.trialregister.nl/trial/3698). Prospectively registered on February 21, 2013.
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Affiliation(s)
- M M H T van Egmond
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 377, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - J P C Grutters
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 715, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 133, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - G Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 715, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - N van Heerbeek
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 377, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - M M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 715, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Route 133, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
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46
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Ma Q, Su K, Fu Z, Wang P, Shi H. Anxiety and depression in patients with nasal septal deviation. Am J Otolaryngol 2020; 41:102450. [PMID: 32183991 DOI: 10.1016/j.amjoto.2020.102450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Nasal septal deviation (NSD) has a significant impact on patients' quality of life; however, there have been limited studies examining the psychological status of NSD patients. In this study, symptoms of depression and anxiety were investigated between NSD patients and controls using a self-report questionnaire. METHODS A case-control study design was used to evaluate the psychological burden of NSD in patients who visited the general hospital. The control group comprised of ENT outpatients without a history of chronic nasal disease. The Zung Self-rating Anxiety/Depression Scale (SDS/SAS) was used to evaluate the prevalence and severity of anxiety and depression between the NSD and control group. RESULTS Seventy-six patients with NSD and 79 control patients were enrolled in the study. We found that depression and anxiety, as well as the co-morbidity of depression with anxiety, were more common in the NSD group in comparison to the control (39.5% vs 22.8%, p = 0.025; 38.2% vs 15.2%, p = 0.001; and 27.6% vs 11.4%, p = 0.011, respectively). The average SDS and SAS score was higher in NSD patients compared to controls (SDS: 49.7 ± 13.1 vs 45.2 ± 10.4, p = 0.019 and SAS: 48.1 ± 11.6 vs 41.3 ± 9.3, p < 0.001, respectively), and NSD patients were found to have more severe levels of anxiety and depression. CONCLUSION Depression and anxiety are more common and severe in patients with NSD. Therefore, psychological distress should be taken into consideration during the diagnostic and therapeutic process for patients with NSD.
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Virtual septoplasty: a method to predict surgical outcomes for patients with nasal airway obstruction. Int J Comput Assist Radiol Surg 2020; 15:725-735. [PMID: 32078099 DOI: 10.1007/s11548-020-02124-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE A deviated nasal septum is the most common etiology for nasal airway obstruction (NAO), and septoplasty is the most common surgical procedure performed by ear-nose-throat surgeons in adults. However, quantitative criteria are rarely adopted to select patients for surgery, which may explain why up to 50% of patients report persistent or recurrent symptoms of nasal obstruction postoperatively. This study reports a systematic virtual surgery method to identify patients who may benefit from septoplasty. METHODS One patient with symptoms of NAO due to a septal deviation was selected to illustrate the virtual surgery concept. Virtual septoplasty was implemented in three steps: (1) determining if septal geometry is abnormal preoperatively, (2) virtually correcting the deviation while preserving the anatomical shape of the septum, and (3) estimating the post-surgical improvement in airflow using computational fluid dynamics. Anatomical and functional changes predicted by the virtual surgery method were compared to a standard septoplasty performed independently from the computational analysis. RESULTS A benchmark healthy nasal septum geometry was obtained by averaging the septum dimensions of 47 healthy individuals. A comparison of the nasal septum geometry in the NAO patient with the benchmark geometry identified the precise locations where septal deviation and thickness exceeded the healthy range. Good agreement was found between the virtual surgery predictions and the actual surgical outcomes for both airspace minimal cross-sectional area (0.05 cm2 pre-surgery, 0.54 cm2 virtual surgery, 0.50 cm2 actual surgery) and nasal resistance (0.91 Pa.s/ml pre-surgery, 0.08 Pa.s/ml virtual surgery, 0.08 Pa.s/ml actual surgery). CONCLUSIONS Previous virtual surgery methods for NAO were based on manual edits and subjective criteria. The virtual septoplasty method proposed in this study is objective and has the potential to be fully automated. Future implementation of this method in virtual surgery planning software has the potential to improve septoplasty outcomes.
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48
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van Egmond MM, Rovers MM, Hannink G, Hendriks CT, van Heerbeek N. Septoplasty for nasal obstruction - Authors' reply. Lancet 2020; 395:494-495. [PMID: 32061294 DOI: 10.1016/s0140-6736(19)32953-8] [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] [Received: 11/04/2019] [Accepted: 11/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Machteld Mht van Egmond
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands.
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands; Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Carine Tm Hendriks
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands
| | - Niels van Heerbeek
- Department of Otorhinolaryngology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 Nijmegen, Netherlands
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49
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Pendolino AL, Randhawa P, Unadkat S, Andrews PJ. Septoplasty for nasal obstruction. Lancet 2020; 395:493. [PMID: 32061292 DOI: 10.1016/s0140-6736(19)33013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Premjit Randhawa
- Royal National Throat, Nose and Ear Hospital, London WC1X 8DA, UK
| | - Samit Unadkat
- Royal National Throat, Nose and Ear Hospital, London WC1X 8DA, UK
| | - Peter J Andrews
- Royal National Throat, Nose and Ear Hospital, London WC1X 8DA, UK; Ear Institute, University College London, London, UK
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50
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Tan NC, Leong SC. Septoplasty for nasal obstruction. Lancet 2020; 395:493-494. [PMID: 32061291 DOI: 10.1016/s0140-6736(19)33012-0] [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] [Received: 07/16/2019] [Accepted: 11/28/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Neil C Tan
- Royal Cornwall Hospital NHS Trust, Truro TR1 3LQ, UK.
| | - Samuel C Leong
- The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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