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Xavier R, Azeredo-Lopes S, Menger DJ, Cyrne de Carvalho H, Spratley J. Which Nasal Airway Dimensions Correlate with Nasal Airflow and with Nasal Breathing Sensation? Facial Plast Surg Aesthet Med 2024; 26:601-606. [PMID: 34492200 DOI: 10.1089/fpsam.2021.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Rhinoplasty modifies the nasal pyramid, thereby also modifying the nasal airway. Objectives: To correlate the sensation of nasal breathing, as measured by patient-reported outcome measures, and nasal airflow, as assessed by peak nasal inspiratory flow (PNIF), with nasal airway dimensions, as measured on computed tomography (CT) images. Methods: Fifty Caucasian patients were studied through visual analogue scale (VAS), nasal obstruction symptom evaluation (NOSE) and PNIF. Measurements of the nasal airway were made on CT images: minimal distance between septum and inferior and middle turbinates, nasal valve angle, and nasal valve area. Results: There was a significant association between PNIF and nasal valve area, between VAS and the narrower nasal valve angle and between NOSE and minimal distance between septum and middle turbinate of the narrower side. Conclusions: This study suggests that the dimensions of the nasal valve and of the middle nasal airway have a substantial impact on nasal breathing capacity. It also highlights the importance of unilateral nasal airway obstruction to nasal breathing.
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Affiliation(s)
- Rui Xavier
- Department of Otorhinolaryngology, Hospital Luz Arrabida, Vila Nova de Gaia, Portugal
| | | | - Dirk Jan Menger
- Department of Facial Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jorge Spratley
- Faculdade de Medicina da Universidade do Porto, Centro Hospitalar e Universitário S.João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal
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2
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Chiang H, Frank-Ito DO. Comparing Patient-Reported Outcomes with Computational Fluid Dynamics-Derived Nasal Airflow After Nasal Airway Surgery: Prioritizing the Patient's Perception of Nasal Obstruction. Facial Plast Surg Aesthet Med 2024. [PMID: 39142699 DOI: 10.1089/fpsam.2024.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
Background: Some patients report persistent nasal obstruction after surgical treatment despite objective improvement. Objective: To compare patients' perceptions of nasal obstruction after surgery with objective nasal airflow as determined by computational fluid dynamics (CFD) modeling: (1) Is perception driven by a more symptomatic side? (2) Can symptom improvement be predicted with CFD modeling? Methods: Pre/postoperative Nasal Obstruction Symptom Evaluation (NOSE) and visual analog scale (VAS) score were collected for patients undergoing nasal obstruction surgery. Pre/postoperative computed tomography was used to generate patient-specific airway models for CFD simulation at 15 L/min resting inspiration. Results: Ten patients (22-53 years, seven men and three women) underwent septoplasty, turbinate reduction, and/or rhinoplasty. Postoperative NOSE was most correlated with postoperative VAS score from the "affected" side (R2 = 0.59, p < 0.01), and postoperative NOSE was strongly predicted by a two-parameter model using parameters only from the "affected" side (R2 = 0.84, adjusted R2 = 0.80, p < 0.01). Conclusion: The postoperative state of the initially "affected" side drives outcomes after nasal obstruction surgery. Surgeries should prioritize improving the "affected" side. A two-parameter model using the VAS and nasal airflow from only the "affected" side strongly predicts NOSE and is promising for the future using virtual planning to individualize procedures to optimize outcome.
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Affiliation(s)
- Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, USA
| | - Dennis O Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina, USA
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Root ZT, Wu Z, Lepley TJ, Schneller AR, Chapman RJ, Formanek VL, Kelly KM, Otto BA, Zhao K. Oxymetazoline as a predictor of turbinate reduction surgery outcomes: Objective support from a prospective, single-blinded, computational fluid dynamics study. Int Forum Allergy Rhinol 2024. [PMID: 39132819 DOI: 10.1002/alr.23422] [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: 03/28/2024] [Revised: 07/02/2024] [Accepted: 07/19/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND A patient's subjective response to topical nasal decongestant is often used to screen for turbinate reduction surgery suitability. However, this anecdotal strategy has not been objectively and quantitatively evaluated. METHODS Prospective, longitudinal, and single-blinded cohort study employing computational fluid dynamic modeling based on computed tomography scans at baseline, 30 min postoxymetazoline, and 2 months postsurgery on 11 patients with chronic turbinate hypertrophy. RESULTS Nasal obstruction symptom evaluation (NOSE) and visual analogue scale (VAS) obstruction scores significantly improved from baseline to postoxymetazoline and again to postsurgery (NOSE: 71.82 ± 14.19 to 42.27 ± 25.26 to 22.27 ± 21.04; VAS: 6.09 ± 2.41 to 4.14 ± 2.20 to 2.08 ± 1.56; each interaction p < 0.05), with significant correlation between the latter two states (r∼0.37-0.69, p < 0.05). Oxymetazoline had a broader anatomical impact throughout inferior and middle turbinates than surgery (many p < 0.05); however, the improvement in regional airflow is similar (most p > 0.05) and predominantly surrounding the inferior turbinate. Strong postoxymetazoline to postsurgery correlations were observed in decreased nasal resistance (r = 0.79, p < 0.05), increased regional airflow rates (r = -0.47 to -0.55, p < 0.05) and regional air/mucosa shear force and heat flux (r = 0.43 to 0.58, p < 0.05); however, only increasing peak heat flux significantly correlated to symptom score improvement (NOSE: r = 0.48, p < 0.05). CONCLUSION We present the first objective evidence that the "topical decongestant test" can help predict turbinate reduction surgery outcomes. The predictive effect is driven by similar improvementin regional airflow that leading to improved air/mucosa stimulations (peak heat flux) rather than through reduced nasal resistance.
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Affiliation(s)
- Zachary T Root
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Zhenxing Wu
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Thomas J Lepley
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Aspen R Schneller
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Robbie J Chapman
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Veronica L Formanek
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kathleen M Kelly
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Bradley A Otto
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kai Zhao
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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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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5
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Xavier R. Overview of Nasal Airway and Nasal Breathing Evaluation. Facial Plast Surg 2024; 40:268-274. [PMID: 38331036 DOI: 10.1055/s-0044-1779043] [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: 02/10/2024] Open
Abstract
Several methods are available for evaluating nasal breathing and nasal airflow, as this evaluation may be made from several different perspectives.Physiologic methods for nasal airway evaluation directly measure nasal airflow or nasal airway resistance, while anatomical methods measure nasal airway dimensions. Subjective methods evaluate nasal breathing through several validated patient-reported scales assessing nasal breathing. Computational fluid dynamics evaluates nasal airflow through the analysis of several physics' variables of the nasal airway.Being familiar to these methods is of utmost importance for the nasal surgeon to be able to understand data provided by the different methods and to be able to choose the combination of evaluation methods that will provide the information most relevant to each clinical situation.
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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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7
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Yong CW, Quah B, Ng WH, Lai WMC, Sim YF, Wong RCW. Maxillary Impaction Does Not Negatively Affect the Nasal Airway: A Systematic Review With Meta-Analysis. J Oral Maxillofac Surg 2023; 81:1227-1243. [PMID: 37478897 DOI: 10.1016/j.joms.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Le Fort I maxillary impaction is an orthognathic surgical procedure to reposition the maxillary complex superiorly. The objective of this study is to investigate if maxillary impaction negatively affects the nasal airway. METHODS A systematic review with meta-analysis was performed to investigate the effects of maxillary impaction on the nasal cavity. PubMed, Embase, and Cochrane Library databases were accessed. Observational studies, nonrandomized, and randomized controlled trials were included if Le Fort 1 maxillary impaction and nasal airway outcomes assessments were performed. Studies were excluded if maxillary impaction or nasal airway outcome assessment was not performed or if the study included patients with cleft or craniofacial syndromes, previous nasal surgeries, or active respiratory tract. The demographic data, study methodology, magnitude of maxillary impaction, and outcomes related to the nasal airway were collected. These outcomes includes anatomical changes (evaluated by rhinoscopy, acoustic rhinometry, and computed tomography), changes to nasal airflow and resistance (evaluated by rhinomanometry) and changes to quality of life. RESULTS The search yielded 7517 studies. Ten studies were included after the application of the selection criteria. A total of 126 patients underwent pure maxillary impaction, 97 underwent maxillary impaction and advancement, and 12 had impaction with setback. Despite that maxillary impactions decreased the nasal cavity volume by +21.7%, the cross-sectional area of the narrowest parts of the cavity was only reduced by -8.4%. Maxillary impactions generally increases the nasal airflow (+12.6%) while reducing nasal resistance (-20.2%). Rhinoscopies also showed a reduction in nasal obstruction. CONCLUSION Maxillary impaction did not negatively affect the nasal airway. The surgeries did not lead to the reduction of the cross-sectional area at the strictures of the nasal cavities. The nasal airflow and resistance was not decreased and increased, respectively. The quality of life of the patients was also not shown to have worsened.
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Affiliation(s)
- Chee Weng Yong
- Assistant Professor, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Bernadette Quah
- Postgraduate, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Wee Hsuan Ng
- Registrar Professor, Department of Oral and Maxillofacial Surgery, Khoo Teck Puat Hospital Singapore, Singapore, Singapore
| | - Wei Ming Clement Lai
- Biostatistician, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Yu Fan Sim
- Biostatistician, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Raymond Chung Wen Wong
- Associate Professor, Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
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8
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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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9
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García-Chabur MA, Castellanos J, Corredor-Rojas G, Salgar M, Moreno S, Pinzón M, Peñaranda A. Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study. Int Arch Otorhinolaryngol 2023; 27:e266-e273. [PMID: 37125370 PMCID: PMC10147458 DOI: 10.1055/s-0042-1743462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/16/2021] [Indexed: 02/16/2023] Open
Abstract
Abstract
Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures.
Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes.
Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables.
Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53–- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores.
Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.
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Affiliation(s)
- María A. García-Chabur
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Juliana Castellanos
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | | | - Mariana Salgar
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | - Sergio Moreno
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Martín Pinzón
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
- Department of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Augusto Peñaranda
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Department of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
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10
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Smith DH, Daines BS, Cazzaniga J, Bhandarkar ND. Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease. Cureus 2023; 15:e34280. [PMID: 36855496 PMCID: PMC9968500 DOI: 10.7759/cureus.34280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.
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Affiliation(s)
- Drew H Smith
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Benjamin S Daines
- Department of Otolaryngology - Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Juliana Cazzaniga
- Department of Otolaryngology - Head and Neck Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Naveen D Bhandarkar
- Department of Otolaryngology - Head and Neck Surgery, University of California Irvine, Orange, USA
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11
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İnan S, Yığman F. The Effect of Acceptance of Cosmetic Surgery, Body Appreciation, and Nasal Obstruction on Patient Satisfaction After Rhinoplasty. Facial Plast Surg Aesthet Med 2022; 25:206-211. [PMID: 36169630 DOI: 10.1089/fpsam.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: It is difficult to predict functional and aesthetic results and provide patient satisfaction after rhinoplasty. Objective: To investigate the effect of nasal obstruction, body appreciation, and acceptance of cosmetic surgery (ACS) in predicting patient satisfaction postrhinoplasty. Methods: We prospectively included 97 consecutive participants who underwent rhinoplasty. We recorded age, gender, marital status, education, and body mass index (BMI), and nasal obstruction symptom evaluation (NOSE) scale, body appreciation scale-2 (BAS-2), acceptance of cosmetic surgery scale (ACSS), and rhinoplasty outcome evaluation (ROE) scale were determined preoperatively and at the 3-month postoperative follow-up. Results: The preoperative and postoperative NOSE, BAS-2, ACSS, and ROE scores differed significantly. The mean ROE score improved from 36.8 preoperatively to 82.1 postoperatively. The ROEpostop score was not correlated significantly with age, BMI, ACSSpreop, BAS-2postop, or ACCSpostop. The BAS-2preop scores were correlated significantly with ACCSpreop and ACSSpostop scores. The NOSEpreop and BAS-2preop scores were significant predictors of the ROEpostop scores in the regression analysis. Conclusion: Preoperative nasal obstruction and body appreciation, but not ACS, are factors that might affect patient satisfaction after rhinoplasty.
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Affiliation(s)
- Serhat İnan
- Department of Otorhinolaryngology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Fatih Yığman
- Department of Psychiatry, Faculty of Medicine, Ufuk University, Ankara, Turkey
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12
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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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13
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Xavier R, Azeredo-Lopes S, Menger DJ, Carvalho HCD, Spratley J. Comparative Functional Effect of Alternative Surgical Techniques Used in Rhinoplasty. Ann Otol Rhinol Laryngol 2022; 132:638-647. [PMID: 35794799 DOI: 10.1177/00034894221111096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this investigation is to compare the functional effect of the different surgical techniques used for addressing each section of the nose. METHODS Prospective study of 57 consecutive rhinoplasty patients. Patients were evaluated with peak nasal inspiratory flow (PNIF), Nasal Obstruction Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) for nasal obstruction before and 1 year after rhinoplasty. Additionally, esthetic evaluation of the nose was obtained with Rhinoplasty Outcomes Evaluation (ROE). According to the surgical technique used to address each portion of the nose, groups of patients were created and the functional improvement of these groups was compared. RESULTS Using the TukeyHSD multiple pairwise-comparison test, the estimated difference of the increase of PNIF between using spreader grafts and using spreader flaps was 94.9 (95% CI 24.3, 165.5, P = .004) between spreader grafts and neither grafts or flaps was 79.2 (95% CI 5.8, 152.6, P = .03), between spreader grafts and bilateral spreader flaps plus a unilateral spreader graft was 90.2 (95% CI 22.1, 158.2, P = .005). In all other portions of the nose, no significant difference was found in the functional improvement between different surgical techniques. CONCLUSIONS Spreader grafts increase PNIF more significantly than other surgical techniques used for dorsal mid-vault reconstruction. Spreader grafts should be preferred over other techniques whenever an improvement of nasal airflow is required. No significant differences were found between the functional effect of alternative techniques used in other sections of the nose. Additional cohort studies will be necessary to further confirm data from this investigation.
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Affiliation(s)
| | - Sofia Azeredo-Lopes
- Comprehensive Health Research Centre (CHRC) and EpiDoC Unit, CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | - Jorge Spratley
- Faculdade de Medicina da Universidade do Porto, Centro Hospitalar Universitário S.João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal
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14
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Huang C, Chen K, Twu C, Huang H, Hsu H. Comparison between botulinum toxin and steroid septal injection in the treatment of allergic rhinitis. Laryngoscope Investig Otolaryngol 2022; 7:12-21. [PMID: 35155778 PMCID: PMC8823147 DOI: 10.1002/lio2.726] [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: 09/22/2021] [Revised: 12/04/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the effects of botulinum toxin and steroid septal injections in treating allergic rhinitis (AR) by evaluating improvements in the rhinitis control assessment test (RCAT), visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE) scores, and active anterior rhinomanometry (RMM) measurements. METHODS This prospective, single-blinded cohort study was conducted at the Department of Otolaryngology, Taipei City Hospital between January 2017 and December 2018. Ninety-five patients were randomized to receive botulinum toxin, dexamethasone, or normal saline (group A, group B, and placebo, respectively). The main outcome measures were pretreatment subjective nasal symptoms (RCAT, VAS, and NOSE) and active anterior RMM measurements. All measurements were repeated during posttreatment 1, 2, and 3 months. RESULTS No significant difference was observed in pretreatment questionnaire scores and RMM values between the study and placebo groups. The mean posttreatment RCAT, VAS, and NOSE scores after 1 and 2 months significantly improved in the treatment groups compared to placebo. The VAS and NOSE at posttreatment 2 months and RCAT, VAS, and NOSE at posttreatment 3 months were significantly different comparing group A to group B. All RMM parameters showed better values in group A than in group B at 1, 2, and 3 months posttreatment, with significant differences in four parameters in posttreatment 3 months. CONCLUSIONS Botulinum toxin septal injection is a safe treatment option for AR and improves subjective nasal symptoms for 3 months. Botulinum toxin A injection tended to be more effective than steroid septal injection in terms of duration and degree.Level of Evidence: 2b, individual cohort study.
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Affiliation(s)
| | - Kuan‐Wei Chen
- Department of OtolaryngologyTaipei City HospitalTaipeiTaiwan
| | - Chih‐Wen Twu
- Department of OtolaryngologyChanghua Christian HospitalChanghuaTaiwan
- College of MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Hung‐Meng Huang
- Department of OtolaryngologyTaipei City HospitalTaipeiTaiwan
- Department of OtolaryngologySchool of Medicine, College of Medicine, Taipei Medical UniversityTaipeiTaiwan
| | - Hsin‐Chien Hsu
- Department of OtolaryngologyTaipei City HospitalTaipeiTaiwan
- General Education CenterUniversity of TaipeiTaipeiTaiwan
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15
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Srinivasan DG, Hegde J, Ramasamy K, Raja K, Rajaa S, Ganesan S, Velayutham P, Alexander A, Saxena SK. Comparison of the Efficacy of Septoplasty with Nonsurgical Management in Improving Nasal Obstruction in Patients with Deviated Nasal Septum – A Randomized Clinical Trial. Int Arch Otorhinolaryngol 2021; 26:e226-e232. [PMID: 35602281 PMCID: PMC9122760 DOI: 10.1055/s-0041-1730993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/05/2021] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction In the current era, the major indication for septoplasty is nasal obstruction due to deviated nasal septum (DNS). Even though septoplasty is a commonly performed surgery, its effectiveness in relieving nasal obstruction in DNS has not been proven.
Objective The present study involved the measurement of both objective (nasal patency) and subjective (quality of life measures) outcome measures for the evaluation of the efficacy of septoplasty as compared with medical management.
Methods Patients with DNS presenting with nasal obstruction were included and randomized into a septoplasty group or into a nonsurgical management group, with 70 patients in each group. The improvement in nasal obstruction was assessed subjectively by the visual analogue scale (VAS), and the sino-nasal outcome test-22 (SNOT-22) and the nasal obstruction symptom evaluation (NOSE) questionnaires and was measured objectively by assessment of nasal patency by peak nasal inspiratory flow (PNIF) at 0, 1, 3, and 6 months of treatment in both groups.
Results The average VAS, SNOT-22 and NOSE scores for the septoplasty versus the nonsurgical group before treatment were 6.28 versus 6.0, 19.5 versus 15, and 14 versus 12, respectively, and at 6 months post-treatment, the scores were 2.9 versus 5.26, 10 versus 12, and 8 versus 10 (p = 0.001), respectively. The average PNIF scores at 0 and 6 months were 60/50 l/min and 70/60 l/min, respectively, in the septoplasty group (p = 0.001); the scores at 0 and 6 months in the nonsurgical management group were 60/60 l/min and 70/70 l/min, respectively (p = 0.001).
Conclusion Surgical correction of DNS by septoplasty improves nasal obstruction better than nonsurgical management at 6 months postsurgery.
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Affiliation(s)
| | - Jyotirmay Hegde
- Department of Otorhinolaryngology, Columbia Asia Hospital, Whitefield, Bangalore, India
| | - Karthikeyan Ramasamy
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sathish Rajaa
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Sivaraman Ganesan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prabu Velayutham
- Department of Otorhinolaryngology, Shri Venkateshwaraa Medical College and Hospital, Puducherry, India
| | - Arun Alexander
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sunil Kumar Saxena
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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16
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Ta NH, Gao J, Philpott C. A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice. Int Forum Allergy Rhinol 2021; 11:910-923. [PMID: 33417297 PMCID: PMC8248036 DOI: 10.1002/alr.22744] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient-reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations. METHODS A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis. RESULTS In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin' Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5). CONCLUSION Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin' Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.
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Affiliation(s)
- Ngan Hong Ta
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Jack Gao
- ENT DepartmentEast Suffolk and North Essex NHS Foundation TrustColchesterUK
| | - Carl Philpott
- ENT DepartmentJames Paget University Hospital NHS Foundation TrustGreat YarmouthUK
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17
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Xavier R, Azeredo-Lopes S, Menger DJ, de Carvalho HC, Spratley J. Objective measurement and patient-reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow? Clin Otolaryngol 2021; 46:744-751. [PMID: 33533570 DOI: 10.1111/coa.13726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/29/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence has shown that the sensation of nasal breathing is related to variations in nasal mucosa temperature produced by airflow. An appropriate nasal airflow is necessary for changing mucosal temperature. Therefore, the correlation between objective measurements of nasal airflow and patient-reported evaluation of nasal breathing should be dependent on the level of nasal airflow. OBJECTIVES To find if the correlation between patient-reported assessment of nasal breathing and objective measurement of nasal airflow is dependent on the severity of symptoms of nasal obstruction or on the level of nasal airflow. METHODS The airway of 79 patients was evaluated using NOSE score and peak nasal inspiratory flow (PNIF). Three subgroups were created based on NOSE and three subgroups were created based on PNIF level to find if correlation was dependent on nasal symptoms or airflow. RESULTS The mean value of PNIF for the 79 patients was 92.6 L/min (SD 28.1 L/min). The mean NOSE score was 48.4 (SD 24.4). The correlation between PNIF and NOSE was statistically significant (P = .03), but with a weak association between the two variables (r = -.248). Evaluation of correlation based on symptoms demonstrated a weak or very weak association in each subgroup (r = -.250, r = -.007, r = -.104). Evaluation of correlation based on nasal airflow demonstrated a very weak association for the subgroups with middle-level and high PNIF values (r = -.190, r = -.014), but a moderate association for the subgroup with low PNIF values (r = -.404). CONCLUSIONS This study demonstrated a weak correlation between NOSE scores and PNIF values in patients non-selected according to symptoms of nasal obstruction or to airflow. It demonstrated that patients with symptoms of nasal obstruction have different levels of nasal airflow and that low nasal airflow prevents the sensation of good nasal breathing. Therefore, patients with symptoms of nasal obstruction may require improving nasal airflow to improve nasal breathing sensation.
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Affiliation(s)
| | | | | | | | - Jorge Spratley
- Centro Hospitalar e Universitário S. João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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18
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Comparison of nasal airway obstruction with sonoelastography and nose obstruction symptom evaluation scores in children with allergic rhinitis. Turk Arch Pediatr 2021; 56:27-31. [PMID: 34013226 DOI: 10.14744/turkpediatriars.2020.87894] [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: 01/08/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
Objective Nasal airway obstruction caused by inferior turbinate hypertrophy is the most troublesome symptom for patients with allergic rhinitis. The aim of this study was to determine any correlation between different nasal obstruction measurements in children with allergic rhinitis. Material and Methods Nasal airway obstruction was assessed with Sonoelastography, Turkish version of the Nose Obstruction Symptom Evaluation scale, Rhinoconjunctivitis Total Symptom Score and visual analog scale methods in children with allergic rhinitis and the results were compared with a healthy control group. Results Evaluation was made of a total of 68 patients (40 boys and 28 girls [male: female ratio, 1.42]) with a mean age of 13.35±3.35 (range, 7-18) years. The Rhinoconjunctivitis Total Symptom Score, visual analog scale, and Turkish version of the Nose Obstruction Symptom Evaluation scale scores were significantly higher in the AR group than in the control group (p=0.001, p=0.001, p=0.001, respectively). The sonoelastography scores were significantly higher in the AR group than in the control group (p=0.001). Although a positive significant correlation was determined between Rhinoconjunctivitis Total Symptom Score, visual analog scale, and Turkish version of the Nose Obstruction Symptom Evaluation scale scores in terms of AR severity, no relationship was found with the sonoelastography scores (p=0.022, p=0.009, p=0.001, and p=0.0751, respectively). Conclusion The Turkish version of the Nose Obstruction Symptom Evaluation scale and sonoelastography can be used to evaluate nasal obstruction due to inferior turbinate hypertrophy in children with allergic rhinitis.
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19
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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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20
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Declerck CH, Boone C, Pauwels L, Vogt B, Fehr E. A registered replication study on oxytocin and trust. Nat Hum Behav 2020; 4:646-655. [PMID: 32514040 DOI: 10.1038/s41562-020-0878-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/01/2020] [Indexed: 12/31/2022]
Abstract
In an influential paper, Kosfeld et al. (2005) showed that intranasal administration of oxytocin (OT) increases the transfers made by investors in the trust game-suggesting that OT increases trust in strangers. Subsequent studies investigating the role of OT in the trust game found inconclusive effects on the trusting behaviour of investors but these studies deviated from the Kosfeld et al. study in an important way-they did not implement minimal social contact (MSC) between the investors and the trustees in the trust game. Here, we performed a large double-blind and placebo-controlled replication study of the effects of OT on trusting behaviour that yields a power of more than 95% and implements an MSC condition as well as a no-social-contact (NoC) condition. We find no effect of OT on trusting behaviour in the MSC condition. Exploratory post hoc analyses suggest that OT may increase trust in individuals with a low disposition to trust in the NoC condition, but this finding requires confirmation in future research. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 19 October 2018. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.11980368.
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Affiliation(s)
- Carolyn H Declerck
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
| | - Christophe Boone
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
| | - Loren Pauwels
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
| | - Bodo Vogt
- Chair in Empirical Economics and Health Economics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ernst Fehr
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.
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21
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Tian Q, Chu T, Sun H, Pang M. Outcomes of Endonasal Septoplasty and Extracorporeal Septal Reconstruction in Anterocaudal Septal Deviation. EAR, NOSE & THROAT JOURNAL 2020; 100:645S-651S. [PMID: 31996042 DOI: 10.1177/0145561320903147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the functional and aesthetic outcomes of endonasal septoplasty (ES) and extracorporeal septal reconstruction (ESR) in anterocaudal septal deviation. METHODS In this study, patients (n = 46) who underwent nasal septoplasty surgery due to anterocaudal septal deviation during February 2015 to August 2017 were analyzed; 23 patients underwent ES and the others (n = 23) underwent ESR. The decision of whether to use the ES or ESR was randomized by random number table method. Nasal obstruction symptoms evaluation (NOSE) scores, total nasal resistance (TNR), aesthetic visual analog scale (VAS), nasal anatomical angles, and incidence of complications were used to assess the patients in 2 groups. RESULTS The NOSE scores, TNR, aesthetic VAS, tip deviation angle (TDA), nasolabial angle (NLA), nasofrontal angle (NFA) in the ESR group were significantly improved from preoperative to postoperative 1 year, whereas in the ES group, except aesthetic VAS, NLA, NFA, all other postoperative outcomes were improved from preoperative values. The objective and subjective postoperative results of ESR group were better than the ES group except TDA. The incidence of complications was not significantly different between the 2 groups. CONCLUSION Our study have compared the nasal functional and aesthetic outcomes of 2 septoplasty techniques in a randomized controlled trial. The ESR technique is more effective than ES technique in correcting functional and aesthetic disorders caused by anterocaudal septal deviation.
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Affiliation(s)
- Qiushi Tian
- Department of Otolaryngology Head and Neck Surgery, 12648Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Teng Chu
- Department of Otolaryngology Head and Neck Surgery, 12648Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Haimin Sun
- Department of Otolaryngology Head and Neck Surgery, 12648Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Mingjie Pang
- Department of Otolaryngology Head and Neck Surgery, 12648Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
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Total and Unilateral Peak Nasal Inspiratory Flow and Unilateral Visual Analogue Scale: Rationale in Indication and Outcomes of Septoplasty? J Craniofac Surg 2019; 30:2004-2007. [PMID: 31205278 DOI: 10.1097/scs.0000000000005664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Septoplasty is one of the most frequently performed procedures in otorhinolaryngology. Proper selection of patients for septoplasty as well as examination is essential for good outcome of surgery. The aim of this study was to evaluate the suitability of combination of 2 simple, cheap, and easily performed examinations for indication and outcomes of septoplasty to evaluate the effectiveness in this type of surgery. Seventy patients were enrolled from 2 tertiary centers from the period of April 2017 to March 2018, who all underwent septoplasty for nasal septal deviation. Total and unilateral peak nasal inspiratory flow (PNIF), unilateral visual analogue scale, and nasal endoscopy for indication and outcomes of septoplasty were performed. Furthermore, assessment of possible correlation between subjective and objective data before and 3 months after septoplasty was done. Statistical analysis was carried out on the obtained data. Postoperatively the total and both unilateral PNIF measurements increased significantly compared with corresponding preoperative values and similarly means of visual analogue scale scores on both sides decreased 3 months after the procedure. No significant correlation was seen between objective and subjective outcomes neither before the surgery, nor postoperatively. The study confirmed the suitability of using PNIF as a simple and inexpensive tool that can be a reasonable alternative to rhinomanometry and which is able to reflect changes after septoplasty. Simultaneously, along with the expected improvement in the total PNIF and unilateral PNIF on deviated side, a slight but significant improvement in PNIF values on the nondeviated side was also demonstrated.
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Mutlu V. Reply to Z. Lou. Auris Nasus Larynx 2019; 46:957. [PMID: 31472921 DOI: 10.1016/j.anl.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vahit Mutlu
- Department of Otorhinolaryngology, Atatürk University Faculty of Medicine, Otorhinolaryngology Department, 25240 Yakutiye, Erzurum, Turkey.
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Cantone E, Ricciardiello F, Oliva F, De Corso E, Iengo M. Septoplasty: is it possible to identify potential "predictors" of surgical success? ACTA ACUST UNITED AC 2019; 38:528-535. [PMID: 30623898 PMCID: PMC6325657 DOI: 10.14639/0392-100x-2072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022]
Abstract
Septoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.
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Affiliation(s)
- E Cantone
- Department of Neuroscience, ENT Section, "Federico II" University, Naples, Italy
| | - F Ricciardiello
- Department of Otorhinolaryngology, "Cardarelli" Hospital, Naples, Italy
| | - F Oliva
- Department of Otorhinolaryngology, "Cardarelli" Hospital, Naples, Italy
| | - E De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Iengo
- Department of Neuroscience, ENT Section, "Federico II" University, Naples, Italy
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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26
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Radulesco T, Meister L, Bouchet G, Giordano J, Dessi P, Perrier P, Michel J. Functional relevance of computational fluid dynamics in the field of nasal obstruction: A literature review. Clin Otolaryngol 2019; 44:801-809. [PMID: 31233660 DOI: 10.1111/coa.13396] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/15/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nasal airway obstruction (nasal obstruction) is a common symptom affecting the quality of life of patients. It can be estimated by patient perception or physical measurements. Computational fluid dynamics (CFD) can be used to analyse nasal ventilation modalities. There is a lack of comparative studies investigating the correlations between CFD variables and patient perception or physical measurements. OBJECTIVE OF THE REVIEW Our goal was to define correlations between CFD variables and patient perception and physical measurements. We also aimed to identify the most reliable CFD variable (heat flux, WSS, total pressure, temperature…) characterising nasal breathing perception. TYPE OF REVIEW Systematic literature review using PRISMA guidelines. SEARCH STRATEGY The selected studies were obtained from the US National Library of Medicine (PubMed) online database, MEDLINE (Ovid), Google Scholar and the Cochrane Library using a combination of MeSH terms (nose, paranasal sinus, fluid dynamics, rhinology) and non-MeSH terms (CFD, nasal airway, nasal airflow, numerical, nasal symptoms). Studies that did not incorporate objective or subjective clinical assessment were excluded. EVALUATION METHOD We compared all results obtained by authors regarding CFD variables and assessment of nasal airway obstruction (clinical or physical). RESULTS To compare nasal obstruction with CFD variables, most authors use CFD-calculated nasal resistances, airflow, heat flux, wall shear stress, total pressure, velocities and streamlines. We found that heat flux appears to be the CFD variable most closely correlated with patient perception. Total pressure, wall shear stress and velocities are also useful and show good correlations. Correlations between CFD-calculated nasal resistances and patient perception are stronger after correction of the nasal cycle. CONCLUSIONS The growing number of CFD studies on the nose has led to a better understanding of nasal obstruction. The clinical interpretation of previously unknown data, such as WSS and heat flux, is opening up new horizons in the understanding of this symptom. Heat fluxes are among the best CFD values correlated with patient perception. More studies need to be performed including temperature and humidity exchanges.
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Affiliation(s)
- Thomas Radulesco
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France.,IUSTI, Aix-Marseille University, Marseille, Cedex, France
| | - Lionel Meister
- IUSTI, Aix-Marseille University, Marseille, Cedex, France
| | - Gilles Bouchet
- IUSTI, Aix-Marseille University, Marseille, Cedex, France
| | | | - Patrick Dessi
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France
| | - Pierre Perrier
- IUSTI, Aix-Marseille University, Marseille, Cedex, France
| | - Justin Michel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France.,IUSTI, Aix-Marseille University, Marseille, Cedex, France
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27
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Muthubabu K, Srinivasan MK, Thejas SR, Sindu M, Vinayak R, Gayathri CS. Quality of Life in Patients with Nasal Septal Deviation After Septal Correction. Indian J Otolaryngol Head Neck Surg 2019; 71:2219-2224. [PMID: 31763324 DOI: 10.1007/s12070-019-01689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
Abstract
Septal Correction is an age-old procedure being practiced for the major part of a century now. The aim of this study was to assess the quality of life after Septal Correction. Fifty patients with complaints of nasal obstruction, trouble breathing via the nose, headache and facial pain were selected for the study. Initial pre-operative assessment was done based on a symptomatic score [Nasal Obstruction Symptom Evaluation Scale (NOSE Scale)]. The presence of a septal deviation was confirmed with an X-ray and computed tomography of the paranasal sinuses along with a diagnostic nasal endoscopy. Based on the extent and location of deviation, the malformed part was corrected. Post-operative assessment was done after a period of 8 weeks based on the NOSE Scale. The results were co-related and documented. It was found that the scores were better post-surgery. Thus, it can be concluded that Septal Correction as a surgical procedure is still relevant in today's World for symptomatic betterment and for a healthier lifestyle.
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Affiliation(s)
- K Muthubabu
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - M K Srinivasan
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - Saai Ram Thejas
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - M Sindu
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - R Vinayak
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
| | - C Surya Gayathri
- Department of Otorhinolaryngology and Neck and Neck Surgery, Meenakshi Medical College, Hospital and Research Institute, Karaipettai Post, Enathur, Kanchipuram, Tamil Nadu 631552 India
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Assessment of non-response in quality control of nasal septal surgery. The Journal of Laryngology & Otology 2019; 133:208-212. [PMID: 30813978 DOI: 10.1017/s002221511900032x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study evaluated the effect of mail non-response on the validity of the results of nasal septal surgery. METHOD Six months post-operatively, questionnaires with both prospective and retrospective ratings were mailed to patients. Patients who did not respond (non-responders) were contacted by telephone. This study compared two cohorts of patients using different interviewers (a nurse and a surgeon). Cohort one consisted of 182 patients (with 67 per cent mail response), and cohort two consisted of 454 patients (with 64.8 per cent mail response). RESULTS In both cohorts, the improvement in obstruction scores was significantly better among mail responders than among non-responders (telephone interviewees) using prospective ratings, but worse using retrospective ratings. CONCLUSION Mail responders had better improvement in nasal obstruction after septoplasty than non-responders. Therefore, low response rates may cause an overestimation of the results. The retrospective ratings obtained through telephone interviews are less reliable because they are influenced by memory and the patients' tendency to give socially acceptable answers.
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Desvant C, Guislain J, Vandenhende-Szymanski C, Mortuaire G. The correlation between active anterior rhinomanometry results and nasal obstruction symptoms scores after inferior turbinate reduction: A prospective cohort study about sixty-five patients. Clin Otolaryngol 2018; 43:1153-1156. [PMID: 29575694 DOI: 10.1111/coa.13101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
- C Desvant
- Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France
| | - J Guislain
- Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France
| | | | - G Mortuaire
- Otorhinolaryngology - Head and Neck Surgery Department, University Hospital, Lille, France.,Lille Inflammation Research International Center -Inserm U995, Université de Lille, Lille, France
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30
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Abstract
The nose, a prominent facial feature in defining facial beauty, is responsible for the fundamental physiologic functions of heating, humidifying, and filtering inspired air. When the normal balance of laminar and turbulent airflow become disturbed due to anatomic abnormalities, nasal obstruction may result. To successfully restore these basic physiologic functions, the surgeon must have a detailed understanding of the nasal anatomy and be able to successfully identify the specific cause of the nasal obstruction. This article discusses the fundamental surgical anatomy and the various diagnostic techniques and instruments at the surgeon's disposal.
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31
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Tsang CLN, Nguyen T, Sivesind T, Cervin A. Long-term patient-related outcome measures of septoplasty: a systematic review. Eur Arch Otorhinolaryngol 2018; 275:1039-1048. [PMID: 29332171 DOI: 10.1007/s00405-018-4874-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Septoplasty is a common rhinological procedure intended to relieve symptoms of chronic nasal obstruction. However, there remains a question as to whether patients obtain symptom improvement and are satisfied with surgical outcomes in the months and years after septoplasty. This review aims to evaluate the long-term efficacy of functional septoplasty for nasal septal deviation. METHODS A systematic review of the literature was conducted from November 2014 to March 2016 using the Cochrane, EMBASE, and PubMed databases. Prospective trials concerning functional septoplasty, which assessed subjective outcomes and included long-term follow-up data (≥ 9 month post-septoplasty) were included. RESULTS 2189 articles were screened with seven meeting the criteria for inclusion. Patient satisfaction was assessed in six studies, with rates of satisfaction provided in three of these, ranging from 69 to 100%. Two studies assessed the degree of patient satisfaction, with one study indicating that 88% of patients were moderately satisfied or better at 1 year post-op, and the other reporting that 50% of patients were satisfied. In assessing symptom relief, several methods were used, including validated questionnaires, with varying degrees of improvement in nasal obstruction reported. CONCLUSIONS Septoplasty appears to be a far from perfect treatment for nasal obstruction due to septal deviation. However, given the heterogeneity of data and lack of randomized controlled trials (RCTs), future RCTs and use of validated questionnaires would enable generation of superior levels of evidence. We suggest future prospective trials evaluating prognostic factors in septoplasty, to better inform patients and facilitate the development of guidelines for surgical intervention.
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Affiliation(s)
- Chi Lap Nicholas Tsang
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia.
| | - Theresa Nguyen
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
| | - Torunn Sivesind
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
| | - Anders Cervin
- Royal Brisbane Clinical Unit, Faculty of Medicine, University of Queensland, Level 9, Health Sciences Building, Brisbane, QLD, Australia
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32
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Standlee AG, Hohman MH. Evaluating the Effect of Spreader Grafting on Nasal Obstruction Using the NOSE Scale. Ann Otol Rhinol Laryngol 2017; 126:219-223. [PMID: 28056521 DOI: 10.1177/0003489416685320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Nasal Obstruction Symptom Evaluation (NOSE) scale has been used to demonstrate that surgery improves nasal obstruction, but no study has directly compared surgical techniques. We performed a retrospective study comparing NOSE scores to quantify the effects of spreader grafting on postoperative nasal patency. METHODS We compared NOSE scores of patients who underwent septoturbinoplasty to open septorhinoplasty with spreader graft placement. We used a paired samples t test to evaluate the difference between pre- and postoperative NOSE scores and the improvement in NOSE score between patients who underwent septoturbinoplasty and those who underwent open septorhinoplasty with spreader graft placement. RESULTS Surgery reduced NOSE scores by an average of 46 points ( P < .001). The mean differences in NOSE score across all time points after septoturbinoplasty and septorhinoplasty with spreader graft placement was 40 and 49, respectively. The mean improvement in NOSE score at the second follow-up appointment was 27 for patients who had undergone septoturbinoplasty and 51 for patients who had undergone septorhinoplasty with spreader graft placement ( P = .04). CONCLUSION This is the largest study quantifying the effect of spreader grafting. Greater improvement was observed from septorhinoplasty with spreader graft placement than septoturbinoplasty, and this improvement persisted over time.
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Affiliation(s)
- Aurora G Standlee
- 1 Department of Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Marc H Hohman
- 1 Department of Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
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