Rhinomanometry evaluation of the effects of pre- and post-operative SMR on exercise

Our Septoplasty Results: Evaluation with the Nose Scale

OBJECTIVE

The aim of this study was to evaluate the effectiveness of septoplasty and septoplasty +  bilateral radio frequency ablation of inferior turbinate (b-RFAIT) according to the type of operation, age groups, gender of patients, and the duration of control period by using Nasal Obstruction Symptom Evaluation (NOSE) Scale.

MATERIALS AND METHODS

Prospective observational study was undertaken in the otolaryngology department of a training hospital. Using the NOSE scale, the study prospectively compared the results of septoplasty only and septoplasty with b-RFAIT in the treatment of nasal obstruction caused by the combination of septal deviation and turbinate hypertrophy. Patients were divided into 2 groups. The first group had only septoplasty and the second group had septoplasty with b-RFAIT. General and local anesthesia were applied in both groups. To review clinical success, all patients were controlled at the 1st week, 1st month, and 3rd month.

RESULTS

One hundred seventy-eight adult patients (male/female: 127/51) with chronic nasal obstruction complaint were enrolled in this prospective study. Our data demonstrated significant improvement from baseline after 24 months for the NOSE scores in both the septoplasty and septoplasty + b-RFAIT groups. No statistical difference was noted in the amount of postoperative improvement between the 2 treatment groups (P = 0.306). No significant difference was observed between general and local anesthesia with respect to patients' preop and postop mean scores (P > 0.05). There was a significant difference between the age of patients' postoperative mean (P < 0.001). There were 4 postoperative means with respect to control time. There was an 82.29% decrease in the complaints of patients at 0 to 6 months, 80.51% decrease at 7 to 12months, 76.1% decrease at 13 to 18 months, and 59.67% decrease at 19 to 24 months. Only the last group had a significant difference regarding mean change in scores (P < 0.001).

CONCLUSIONS

This study shows that septoplasty + bilateral turbinate radiofrequency should be applied to patients who suffer from septum deviation with concha hypertrophy. Postoperative NOSE scale shows that the success of operation does not depend on the gender of patients and operation types (general or local anesthesia). We conclude that younger patients (18-40 age) who have obstruction with septal deviation and septum deviation with concha hypertrophy benefit more from operation than older patients do.

Impact of Septal Correction on the Blood Pressure of Hypertensive Patients with Deviated Nasal Septum

This study aims to evaluate the effect of septal correction on the blood pressure (BP) of patients with symptomatic nasal septal deviation and to assess whether a positive association exists between deviated nasal septum and hypertension. A prospective observational clinical study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. Hundred adults, aged 18-40 years, with symptomatic nasal septal deviation, newly detected untreated hypertension (mean BP ≥140/90 mmHg), undergoing submucosal resection of the septum and submucosal diathermy of hypertrophied inferior turbinate (when present), were included. Postoperative follow up for ENT examination and BP measurement was done at 1, 6 and 12 months. Seventy five males and 25 females met the inclusion criteria. 48 % were aged 31-35 years (mean = 31.83 ± 5.19 years). 71 % had anterior septal deviation, 13 % posterior deviation and 16 % a combination of both. Preoperatively, mean systolic blood pressure was 141.82 ± 1.70 mmHg and mean diastolic blood pressure was 91.04 ± 1.21 mmHg, which postoperatively decreased by 10-12 mmHg and 4-5 mmHg respectively. 79 % showed a significant (P < 0.001) decrease in BP postoperatively. 13 % showed no change in BP, of which 53.8 % had posterior deviation, demonstrating a significant association (P < 0.001) between type of deviation and response to surgery. In 8 %, a rise in BP over the follow up period was seen; of these, 62.5 % were aged 36-40 years, indicating a significant association (P < 0.001) between age and BP. Surgical correction of septal deviation is thus effective in controlling the BP of patients with anterior deviation, aged <35 years.

Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review

BACKGROUND

Nasal septal surgery is a common procedure, but there are concerns that the benefits of this surgery are mainly cosmetic.

OBJECTIVE OF REVIEW

The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

A systematic search of the available literature was performed, using Pubmed, Medline (1950-November 2010), Embase (1947-November 2010) and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre- and post-surgical treatment of nasal obstruction in adults because of septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection and septal (deviation) corrective surgery.

RESULTS

Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry and one study (22 participants) using nasal peak inspiratory flow were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from six studies) decreased from preoperative 1.19 Pa/cm(3) /s to postoperative 0.39 Pa/cm(3) /s, mean minimum cross-sectional area (data from five studies) increased from preoperative 0.45 cm(2) to postoperative 0.61 cm(2) , median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery.

CONCLUSIONS

There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency and that improved nasal airflow may have beneficial effects for the patient.

Septoplasty: long-term evaluation of results

OBJECTIVE

The goal of this study was to ascertain how accurately the surgeons' selection criteria for septoplasty, which largely relies on clinical judgement alone, is able to anticipate patients' long-term satisfaction.

STUDY DESIGN AND SETTING

A 10-year retrospective study was undertaken in a tertiary care otorhinolaryngology center.

METHODS

All patients who underwent septoplasty at the same otorhinolaryngology department in the past 2 to 10 years were mailed a questionnaire to evaluate their perception of the procedure's results. Clinical files were reviewed to establish the initial type of septal deformity. Because some surgeons used rhinomanometry to support their decision to recommend surgery, its capability of predicting patients' satisfaction was simultaneously assessed.

RESULTS

Subjects with anterior septal deformities were shown to benefit the most from septoplasty. Selection of patients on clinical grounds alone does carry, however, a considerable risk of patient dissatisfaction with end results. Nevertheless, despite a very strong correlation between anterior septal deviations and increased nasal resistance, preoperative rhinomanometry data failed to prove useful in predicting the long-term surgical outcome.

CONCLUSIONS

Surgeons' appreciation of the types of septal deviation that do benefit from surgical correction falls short of desirable. Patients' satisfaction, however, did not improve if rhinomanometry was included in the preoperative evaluation.

Objective and subjective nasal airflow

PURPOSE

This study was designed to assess whether a correlation exists between the rhinomanometric measurement of nasal resistance, nasal airflow, and the subjective sensation of airflow.

MATERIALS AND METHODS

Sixteen patients with recurrent maxillary sinusitis were examined before and after uncinectomy during functional endoscopic sinus surgery. Subjective nasal sensation of airflow was assessed by means of a visual scale before and after uncinectomy. Rhinomanometry was performed three times for every patient: before anesthesia, and before and after uncinectomy. The subjective nasal sensation of airflow was compared with the nasal airflow and resistance to flow as measured by rhinomanometry.

RESULTS

Rhinomanometric measurements were almost the same before and after uncinectomy, with no significant difference, whereas patients reported a significant improvement in nasal airflow.

CONCLUSION

Rhinomanometric measurements of nasal airflow and resistance often have no correlation to the patients's sensation of airflow. However, because it is the patients' ultimate concern to breathe more comfortably, the rhinomanometer has little clinical value.