1
|
Rossi Meyer MK, Most SP. Quantifying the Subjective Experience of Nasal Obstruction: A Review. Facial Plast Surg 2024; 40:336-340. [PMID: 37625460 DOI: 10.1055/a-2160-4998] [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: 08/27/2023] Open
Abstract
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
Collapse
Affiliation(s)
- Monica K Rossi Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
2
|
Russel SM, Chiang H, Finlay JB, Shah R, Marcus JR, Jang DW, Abi Hachem R, Goldstein BJ, Frank-Ito DO. Characterizing Olfactory Dysfunction in Patients with Unilateral Cleft Lip Nasal Deformities. Facial Plast Surg Aesthet Med 2023; 25:457-465. [PMID: 37130297 PMCID: PMC10701508 DOI: 10.1089/fpsam.2022.0367] [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: 05/04/2023] Open
Abstract
Background: Unilateral cleft lip nasal deformity (uCLND) is associated with olfactory dysfunction, but the underlying etiology remains poorly understood. Objective: To investigate the etiology of uCLND-associated olfactory dysfunction using clinical, computational, and histologic assessments. Methods: Inclusion criteria: uCLND patients >16 years undergoing septorhinoplasty. Exclusion criteria: prior septoplasty or rhinoplasty, pregnancy, sinusitis. Measured outcomes: patient-reported scores, rhinomanometry, smell identification and threshold tests, computational fluid dynamics (CFD) airflow simulations, and histologic analysis of olfactory epithelium. Results: Five uCLND subjects were included: 18-23 years, three male and two female, four left-sided cleft and one right-sided cleft. All subjects reported moderate to severe nasal obstruction. Smell identification and threshold tests showed varying degrees of hyposmia. Nasal resistance was higher on the cleft side versus noncleft side measured by rhinomanometry (median 3.85 Pa-s/mL, interquartile range [IQR] = 21.96, versus 0.90 Pa-s/mL, IQR = 5.17) and CFD (median 1.04 Pa-s/mL, IQR = 0.94 vs. 0.11 Pa-s/mL, IQR = 0.12). Unilateral olfaction varied widely and was dependent on unilateral percentage olfactory airflow. Biopsies revealed intact olfactory neuroepithelium. Conclusions: uCLND-associated olfactory dysfunction appears to be primarily conductive in etiology and highly susceptible to variations in nasal anatomy. Clinical Trial Registration number: NCT04150783.
Collapse
Affiliation(s)
- Sarah M. Russel
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - John B. Finlay
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Medical Scientist Training Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Reanna Shah
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey R. Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - David W. Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Bradley J. Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Dennis Onyeka Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, North Carolina, USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, North Carolina, USA
| |
Collapse
|
3
|
Warinner C, Loyo M, Gu J, Wamkpah NS, Chi JJ, Lindsay RW. Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation. Facial Plast Surg 2023; 39:517-526. [PMID: 37290455 DOI: 10.1055/s-0043-1769806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.
Collapse
Affiliation(s)
- Chloe Warinner
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Jeffrey Gu
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Nneoma S Wamkpah
- Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Robin W Lindsay
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| |
Collapse
|
4
|
Tollefson TT. The Right Time for a Special Issue on Rhinoplasty. Facial Plast Surg Aesthet Med 2022; 24:141-142. [DOI: 10.1089/fpsam.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Travis T. Tollefson
- Editor-in-Chief
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| |
Collapse
|
5
|
Most SP, Barrera JE, Larrabee WF. Increasing Levels of Evidence in Rhinoplasty: Stepping Up Our Role as Leaders in the Specialty. Facial Plast Surg Aesthet Med 2022; 24:162-164. [DOI: 10.1089/fpsam.2022.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - José E. Barrera
- Department of Surgery, Uniformed Services University, Washington, District of Columbia, USA
- Facial Plastic Surgery, UT Health, San Antonio, Texas, USA
| | - Wayne F. Larrabee
- The Larrabee Center, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|