1
|
Bansberg SF, House T, Marino MJ, Taylor CM, Miglani A. Nasal Septal Perforation Dimensional Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39045761 DOI: 10.1002/ohn.918] [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: 04/20/2024] [Revised: 06/27/2024] [Accepted: 07/14/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To describe and illustrate septal perforation shape through the documentation and analysis of length and height measurements. A secondary objective is to correlate perforation size to surgical and nonsurgical etiologies. STUY DESIGN Retrospective case series. SETTING Tertiary academic medical center. METHODS Length and height of consecutively treated perforations over a 3-year period were measured directly or through computed tomography. Mean differences in length and height measurements were compared and regression analysis used to determine perforation shape and the effect of etiology on perforation size. Perforations were classified by length into small (1-5 mm), medium (6-15 mm), and large (>15 mm) and correlated to shape and etiology. RESULTS One hundred twenty-four patients (mean age 50.4 years, 60.5% female) met study inclusion criteria. Height was less than length in 93% of perforations 5 mm or greater in length. Mean perforation height was significantly less than length for medium and large perforations (P < .001). Mean length and height measurements of nonsurgical perforations were greater than those for surgical perforations (P < .001). CONCLUSION Height is less than length in over 90% of septal perforations. Most perforations assume an elliptical shape as they enlarge. Accurate measurement and presentation of length and height is relevant information to perforation management decisions and for the evaluation of treatment outcomes.
Collapse
Affiliation(s)
- Stephen F Bansberg
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Trenton House
- Mayo Clinic Department of Otolaryngology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Cullen M Taylor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Amar Miglani
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| |
Collapse
|
2
|
Miglani A, Rangel I, Smith C, Bansberg SF, Lal D, Marino MJ. Assessment of a Novel Tool for the Clinical Grading of Nasal Septal Perforation. Laryngoscope 2024; 134:3049-3053. [PMID: 38238894 DOI: 10.1002/lary.31286] [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: 10/24/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Nasal septal perforations (NSP) can have a heterogeneous appearance on endoscopic examination with varying degrees of crusting, inflammatory change, and associated septal deviation. The clinical applicability of these findings as contributors to patient symptoms may be enhanced by use of a standardized assessment. METHODS Video nasal endoscopy recordings were obtained from 40 patients with NSP. Five raters with varied levels of training ranging from a senior resident to an experienced septal perforation surgeon independently reviewed the videos for the following exam findings: crusting, scarring, granulation tissue, septal deviation, and edema. Scoring for each item was reported on a 3-point (0-2) scale, and each reviewer repeated scoring at a 14-day interval. Interrater and intrarater agreement were calculated using Fleiss kappa for each item and the total scores. Additionally, endoscopy scores were correlated with patient-reported NOSE-Perf symptom scores. RESULTS Interrater agreement for the overall instrument was in the "fair-to-moderate" range with the following interrater agreement for each item: crusting (0.458-0.575), scarring (0.286-0.308), granulation (0.403-0.406), deviation (0.487-0.494), and edema (0.253-0.406). Intrarater agreement was generally "substantial" for individual items as well as the overall instrument (0.688). The NSP endoscopy scores were moderately correlated with NOSE-Perf scores (r = 0.44, p = 0.008). CONCLUSIONS An endoscopic evaluation of NSP comprising five exam findings has acceptable interrater and intrarater reliability and correlates with patient-reported outcomes. NSP endoscopy may be applied to future clinical studies for characterization of NSP and assessment of treatment outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3049-3053, 2024.
Collapse
Affiliation(s)
- Amar Miglani
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - India Rangel
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | - Cody Smith
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Stephen F Bansberg
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Devyani Lal
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Michael J Marino
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| |
Collapse
|
3
|
Quer-Castells M, Alegre B, Rojas-Lechuga MJ, Alobid I. Adaptation and validation of the Spanish version of NOSE-Perf questionnaire for septal perforations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:231-237. [PMID: 38432615 DOI: 10.1016/j.otoeng.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Septal perforation (SP) cause heterogeneous symptoms depending on the anatomical location, highlighting scabs, nasal obstruction and/or epistaxis. The use of questionnaires to determine the quality of life in different pathologies is increasing in sinonasal pathologies and in patients with SP the NOSE-Perf questionnaire was constructed, currently validated in English. The aim of this study is the translation, cross-cultural adaptation, and validation of the NOSE-Perf questionnaire into Spanish. MATERIAL AND METHODS Prospective single-centre study of 81 patients (38 with SP and 43 controls), visited in the rhinology section of a tertiary hospital. Adaptation and translation NOSE-Perf into Spanish and validation using the NOSE and NOSE-Perf questionnaire in Spanish. RESULTS Significant differences were found in the mean NOSE-Perf score and in the mean NOSE score (IC95% = 21.2-26.9; p < 0.001 and IC95% = 53.8-70.5; p < 0.001) between SP group and control group. Pearson's correlation between the two questionnaires NOSE-Perf and NOSE in the SP group was 0.74 (95% CI = 0.56-0.86; p < 0.001). In the control group it was r = 0.85 (95%CI = 0.73-0.91; p < 0.001). Cronbach's alpha coefficient of the NOSE-Perf was 0.95 (IC 95% = 0.93-0.96) for internal consistency. The reliability evaluation was carried out by test-retest, and a strong Pearson correlation was obtained between the questionnaires r = 0.94 (CI95% = 0.85-0.97; p < 0.001) and r = 0.89 (95%CI = 0.77-0.95; p < 0.001). CONCLUSIONS The Spanish version of the NOSE-Perf is as reliable and valid as the English version, which makes it possible to assess the impact on quality of life that it causes in patients with perforations in the Spanish-speaking population.
Collapse
Affiliation(s)
| | - Berta Alegre
- Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, Spain
| | - María Jesús Rojas-Lechuga
- Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, Spain; Institute of Biomedical Research 'August Pi i Sunyer' (IDIBAPS), Barcelona, Spain
| | - Isam Alobid
- Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, Spain; Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Institute of Biomedical Research 'August Pi i Sunyer' (IDIBAPS), Barcelona, Spain
| |
Collapse
|
4
|
Taylor CM, Bansberg SF, Marino MJ. Validated Symptom Outcomes Following Septal Perforation Repair: Application of the NOSE-Perf Scale. Laryngoscope 2024; 134:3067-3072. [PMID: 38334159 DOI: 10.1002/lary.31329] [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: 10/26/2023] [Revised: 01/03/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The Nasal Obstruction Symptom Evaluation (NOSE)-Perf scale was developed and validated to measure symptoms associated with nasal septal perforations. This study reports the application of the NOSE-Perf scale to evaluate symptom change following septal perforation repair. METHODS Patients with NOSE-Perf evaluations ≥6 months following attempted perforation closure from July 2018 to December 2021 utilizing bilateral nasal mucosal flaps with an interposition graft were eligible for study inclusion. Change in NOSE-Perf scores were noted. Patient demographics, perforation size, and concurrent functional procedures were analyzed for impact on symptom outcomes. RESULTS One-hundred and seventeen patients met the study criteria. Seventy-nine (67.5%) of the patients were female and the mean (range) age at surgery was 47.3 (14-78) years. Repair failure was noted in 7 (6.0%) patients. Mean (SD) preoperative NOSE-Perf score was 25.3 (95% CI, 23.5-27.1) and postoperative score was 7.9 (95% CI, 6.5-9.3). Minimal clinically important difference (MCID) was estimated and greater than 91% of patients had improvement above this threshold. Patient age, perforation size, or concurrent functional procedures did not impact outcomes. Postoperative scores at short (2-4 months), intermediate (5-8 months), and long-term (≥9 months) time periods showed significant improvement (all p < 0.001) compared to preoperative NOSE-Perf scores. CONCLUSION Significant reduction in nasal symptoms as measured by the NOSE-Perf scale is noted following bilateral mucosal flap repair. Although the nose does not completely normalize following repair, clinically important improvement was noted in at least 91% of patients. The NOSE-Perf scale is positioned to play a role in the standardization of septal perforation evaluation and outcomes assessment. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3067-3072, 2024.
Collapse
Affiliation(s)
- Cullen M Taylor
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Stephen F Bansberg
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Michael J Marino
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| |
Collapse
|
5
|
Alegre Edo B, Rojas-Lechuga MJ, Quer-Castells M, González-Sánchez N, Lopez-Chacon M, Hopkins C, Alobid I. Quality of Life in Symptomatic Septal Perforation. Laryngoscope 2024. [PMID: 38850257 DOI: 10.1002/lary.31557] [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: 02/21/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE The aim of this study is to investigate the impact of septal perforation (SP) on quality of life (QoL). SP is compared to the general population and patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) using the Sino-Nasal Outcome Test 22 (SNOT-22). METHODS Prospective single-center study in a referral Rhinology Unit from January 2014 to March 2023. RESULTS A total of 392 patients were included in three groups: controls (n = 141), CRSwNP (n = 118), and SP (n = 133). The mean score of the SNOT-22 was significantly higher in the CRSwNP group (42.4, SD = 24.4) and SP (46.5, SD = 22) compared to the control group (6.2, SD = 8.4). Scores by either items or domains were significantly higher in the CRSwNP and SP groups compared to the control group. There were no significant differences in the mean SNOT-22 between the CRSwNP and SP groups (p = 0.26; 95% CI -1.68-9.99). Domain-specific analysis of overall SNOT-22 scores revealed that patients with SP experienced higher levels of disturbances in sleep, function, and psychological domains (p ≤ 0.001). CONCLUSION SP produces a negative impact on QoL similar to CRSwNP. Moreover, sleep, psychological, and function domains are significantly worse in SP. Etiology and area of SP influence nasal and emotion domain, though more studies on SP using SNOT-22 and specific questionnaires are needed. LEVEL OF EVIDENCE Level III Laryngoscope, 2024.
Collapse
Affiliation(s)
- Berta Alegre Edo
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - María Jesús Rojas-Lechuga
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Mireia Quer-Castells
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Nesly González-Sánchez
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Mauricio Lopez-Chacon
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Isam Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clínic, Universitat Barcelona, IDIBAPS, CIPERES, Barcelona, Spain
| |
Collapse
|
6
|
Gazmenga FP, Toro MDC, Lau F, Cruz AJR, Costa E, Marino MJ, Sakano E. Translation, cultural adaptation, and validation of the NOSE-Perf scale to Brazilian Portuguese. Braz J Otorhinolaryngol 2024; 90:101442. [PMID: 38834013 PMCID: PMC11178980 DOI: 10.1016/j.bjorl.2024.101442] [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: 01/10/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To perform the translation, cultural adaptation, and validation of the NOSE-Perf Scale to Brazilian Portuguese. METHODS This study was divided into two stages. In the first stage, the questionnaire was submitted for translation and cultural adaptation, following the guidelines recommended by the ISPOR Task Force (International Society for Pharmacoeconomics and Outcomes Research). Then, the Brazilian Portuguese version of the NOSE-Perf scale was applied to a group with septal perforation and a control group. The group with perforation answered the questionnaire again after one month. Internal consistency, test-retest reliability, and discriminant validity were assessed. RESULTS The Brazilian Portuguese version of the NOSE-Perf scale was applied to 32 participants, 16 from the group with septal perforations and 16 controls. The instrument obtained high internal consistency, with Cronbach's alpha scores of 0.986. High reliability was also obtained, with Spearman's correlation coefficient of 0.996 (p < 0.001) and the intraclass correlation coefficient of 0.965 with a 95% Confidence Interval (95% CI) of 0.886‒0.988. The NSP group obtained a mean total score of 13.8 ± 12.6 and the control group a score of 2.3 ± 1.8, with a statistical difference between the groups (p < 0.001), demonstrating good discriminant validity. CONCLUSION The Brazilian Portuguese version of the NOSE-Perf scale is a reliable and valid instrument for measuring symptoms in patients with nasal septum perforations. LEVEL OF EVIDENCE Level 2-Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
Collapse
Affiliation(s)
- Fabio Portella Gazmenga
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Mariana Dalbo Contrera Toro
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Fabio Lau
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Jose Roque Cruz
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Elaine Costa
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Michael J Marino
- Mayo Clinic, Department of Otolaryngology - Head and Neck Surgery, Phoenix, USA
| | - Eulalia Sakano
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| |
Collapse
|
7
|
Leung SW, Brar T, Bansberg SF, Marino MJ, Lal D, Taylor C, Miglani A. Combined endoscopic sinus surgery and endonasal septal perforation repair: Symptom outcomes and perforation closure rates. Int Forum Allergy Rhinol 2024; 14:870-872. [PMID: 37669016 DOI: 10.1002/alr.23265] [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: 06/12/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
KEY POINTS Combined endoscopic sinus surgery and nasal septal perforation repair is technically feasible. NOSE-Perf is a recently developed patient-reported outcome measure for nasal septal perforation. The decision to perform combined ESS and NSP repair should be made on a case-by-case basis.
Collapse
Affiliation(s)
- Sabrina W Leung
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Tripti Brar
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Stephen F Bansberg
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Cullen Taylor
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - Amar Miglani
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| |
Collapse
|
8
|
Chien L, Yver CM, Shohat S, Friedman O. Predictors of Success of Endonasal Septal Perforation Repair: A 10-Year Experience. Facial Plast Surg Aesthet Med 2024; 26:117-123. [PMID: 37782906 DOI: 10.1089/fpsam.2022.0162] [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: 10/04/2023] Open
Abstract
Background: There is no consensus on optimal repair technique for nasal septal perforations (NSPs). Objective: To measure success rate and evaluate predictors of success for NSP repair. Methods: Medical records of patients who underwent NSP repair from 2010 to 2020 were reviewed. Included patients had at least 60 days of postsurgical follow-up. Surgical technique involves an endonasal approach; subperichondrial dissection with local flap mobilization; and multilayer closure using cartilage interposition graft, fascia graft, and mucoperichondrial flaps. A chi-squared test or Fisher exact test was used for statistical analysis. Results: Eighty-one repairs were performed with a closure rate of 86%. The median patient age was 46 years (range 13-77); 34.6% of perforations were ≥2 cm. Conchal (77.8%), rib (7.4%), or septal (7.4%) cartilage was used as graft material. A complication rate of 8.6% was reported. Perforation size or graft material had no impact on successful closure rate. Of patients with failed repairs, 55% had perioperative complications or conditions associated with poor healing. Conclusion: An endonasal approach for NSP repair showed a high success rate across diverse presentations; however, NSP repair was significantly more likely to be successful in patients without perioperative complications or pre-existing conditions associated with poor wound healing.
Collapse
Affiliation(s)
- Lillian Chien
- Division of Facial Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina M Yver
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shirly Shohat
- Department of Plastic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Oren Friedman
- Division of Facial Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Na Y, Kwon KW, Jang YJ. Impact of nasal septal perforation on the airflow and air-conditioning characteristics of the nasal cavity. Sci Rep 2024; 14:2337. [PMID: 38281976 PMCID: PMC10822863 DOI: 10.1038/s41598-024-52755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
We investigated (1) how nasal septal perforations (NSPs) modify nasal airflow and air-conditioning characteristics and (2) how the modifications of nasal airflow are influenced by the size and location of the NSP. Computed tomography scans of 14 subjects with NSPs were used to generate nasal cavity models. Virtual repair of NSPs was conducted to examine the sole effect of NSPs on airflow. The computational fluid dynamics technique was used to assess geometric and airflow parameters around the NSPs and in the nasopharynx. The net crossover airflow rate, the increased wall shear stress (WSS) and the surface water-vapor flux on the posterior surface of the NSPs were not correlated with the size of the perforation. After the virtual closure of the NSPs, the levels in relative humidity (RH), air temperature (AT) and nasal resistance did not improve significantly both in the choanae and nasopharynx. A geometric parameter associated with turbinate volume, the surface area-to-volume ratio (SAVR), was shown to be an important factor in the determination of the RH and AT, even in the presence of NSPs. The levels of RH and AT in the choanae and nasopharynx were more influenced by SAVR than the size and location of the NSPs.
Collapse
Affiliation(s)
- Yang Na
- Department of Mechanical Engineering, Konkuk University, Seoul, 05029, Korea
| | - Kyung Won Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| |
Collapse
|
10
|
Taylor CM, Marino MJ, Bansberg SF. Septal Perforation Repair Quality of Life Outcomes Using the Revised 15-item Glasgow Benefit Inventory. Ann Otol Rhinol Laryngol 2023; 132:1550-1556. [PMID: 37157824 DOI: 10.1177/00034894231170938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The 18-item Glasgow Benefit Inventory (GBI) has been widely used to measure patient general health response to otorhinolaryngologic and facial plastic interventions. The GBI was recently reorganized into 15 questions with 5 sub-scale factors (GBI-5F) to improve its utility. Application of the GBI-5F to septal perforation treatments may improve our understanding of quality of life outcomes. METHODOLOGY/PRINCIPAL The GBI was given to patients seen from August 2018 through October 2021 who were at least 6 months postoperative attempted perforation surgical closure using bilateral nasal mucosal flaps with an interposition graft. Original GBI and GBI-5F scores were computed and subgroup analysis performed in this retrospective medical record review. RESULTS Of the 98 patients (mean age 45.5 years) who met study criteria, 65 were female. Mean perforation length was 12.9, and height 9.7 mm. The mean postoperative time to GBI completion was 12.7 months. Highest GBI-5F scores were noted in the Quality of Life factor, followed by Self-confidence and Social Involvement. Females reported significantly higher scores than men. Total GBI scores were similar to those recorded for other rhinologic procedures. CONCLUSIONS The GBI-5F provides measurable insight into patient quality of life benefit following septal perforation repair.
Collapse
Affiliation(s)
- Cullen M Taylor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Michael J Marino
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Stephen F Bansberg
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
11
|
Davis SJ, Rossi Meyer M, Misch E, McLeod M, Occhiogrosso J, Yau J, Mims M, Dedhia RD, Sowder JC, Shockley R, Cerrati E, Shaye D, Shockley W, Owen S, Stephan SJ. Septal Perforation Repair Using a Temporoparietal Fascia and Polydioxanone Plate Construct: A Multi-Institutional Analysis. Facial Plast Surg Aesthet Med 2022; 25:212-219. [PMID: 36173756 DOI: 10.1089/fpsam.2021.0421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)-polydioxanone (PDS) plate interposition grafting. Objectives: To compare rates of NSP closure with TPF-PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors. Methods: Retrospective review of patients undergoing TPF-PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications. Results: Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm2. NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors. Conclusions: TPF-PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.
Collapse
Affiliation(s)
- Seth J. Davis
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Monica Rossi Meyer
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emily Misch
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan McLeod
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Jenny Yau
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Marc Mims
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Raj D. Dedhia
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Justin C. Sowder
- Department of Otolaryngology – Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
- Center for Facial Plastic and Reconstructive Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Ross Shockley
- Department of Otolaryngology – Head and Neck Surgery, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric Cerrati
- Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Shaye
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Shockley
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Scott Owen
- Department of Otolaryngology – Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of Facial Plastic and Reconstructive Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott J. Stephan
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
12
|
Taylor CM, Marino MJ, Bansberg SF. Presenting Symptomatology for Patients With Nasal Septal Perforation: Application of the
NOSE‐Perf
Scale. Laryngoscope 2022; 133:1315-1320. [PMID: 35869840 DOI: 10.1002/lary.30299] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To objectively identify and quantitate presenting nasal symptoms in patients with a septal perforation using the validated NOSE-Perf scale. STUDY DESIGN Case series retrospective review. METHODS The medical records from August 2018 through January 2022 of patients at a tertiary care academic center with a septal perforation, and who completed the NOSE-Perf questionnaire, were reviewed. Perforation symptoms were identified and quantified using the 12-item NOSE-Perf scale (score range 0-48). NOSE-Perf findings were correlated to patient demographics, perforation etiology, and perforation length. NOSE-Perf scores of patients who pursued treatment were compared with those who did not. RESULTS NOSE-Perf data were collected from 202 patients. Nasal crusting was noted in 94.1% of patients and was the most severe symptom reported (mean 2.9 of 4.0). Nasal congestion, difficulty breathing, and nasal obstruction followed in prevalence and severity. The mean total NOSE-Perf score was 23.7. Linear regression analysis demonstrated a weakly negative association of NOSE-Perf score with patient age and weakly positive association with increasing perforation length. NOSE-Perf scores were significantly higher in women and in patients pursuing treatment. CONCLUSION This is the first study to use the validated NOSE-Perf scale to objectively characterize and establish baseline septal perforation symptomatology. The NOSE-Perf scale can play a role in the standardization of perforation evaluation and treatment outcomes assessment. Laryngoscope, 133:1315-1320, 2023.
Collapse
Affiliation(s)
- Cullen M. Taylor
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic in Arizona Phoenix Arizona U.S.A
| | - Michael J. Marino
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic in Arizona Phoenix Arizona U.S.A
| | - Stephen F. Bansberg
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic in Arizona Phoenix Arizona U.S.A
| |
Collapse
|
13
|
Levin M, Ziai H, Shapiro J, Roskies MG. Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review. Facial Plast Surg 2022; 38:428-433. [PMID: 35189658 DOI: 10.1055/s-0042-1743251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Nasal septal perforation is an uncommon pathology that is difficult to surgically repair and may significantly impact patients' quality of life. Existing treatments have high complication and failure rates. The use of polydioxanone (PDS) plates to repair septal perforations is an innovative approach that has demonstrated superior outcomes to the conventional techniques. This study aimed to review the literature on PDS plates for nasal septal perforation reconstruction. PubMed, OVID Medline, and OVID Embase databases were searched for relevant articles in June 2021. Search terms included nasal septal perforation, polydioxanone, septal perforation, septal repair, nasal septum, and PDS plate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to for this systematic review. Database searches yielded 80 articles. Seven articles were included representing 74 patients. All studies reported the use of PDS plates in addition to other materials. They all reported closure rates of at least 80%. The majority of studies reported no postoperative complications. Nasal septal perforation reconstruction with PDS plates is a promising approach that has demonstrated positive outcomes. Further larger studies are required to evaluate the long-term efficacy of using PDS plates on patients with septal perforations.
Collapse
Affiliation(s)
- Marc Levin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Shapiro
- Temerty Faculty of Medicine, University of Toronto Temerty, Toronto, Ontario, Canada
| | - Michael G Roskies
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto Faculty of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Facial Plastic and Reconstructive Surgery, Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|