Effectiveness of septoplasty versus non-surgical management for nasal obstruction due to a deviated nasal septum in adults: study protocol for a randomized controlled trial

The Effect of Training Given to Patients with Septorhinoplasty on Nose Obstruction and Sleep Quality: A Randomized Controlled Prospective Trial

PURPOSE

Clinical nurses play a primary role in the surgical adjustment of patients, to include monitoring and training patients in septorhinoplasty, which has a long recovery period. The effect of repetitive patient training nasal obstruction and sleep quality is unknown. This study aimed to determine the effect of repetitive training given to patients undergoing septorhinoplasty on nasal obstruction and sleep quality.

DESIGN

The study is a randomized controlled prospective study.

METHODS

The study was conducted on a total of 180 patients (intervention: 90, control: 90) who underwent septorhinoplasty. In the intervention group, repeated training was given before and after (12 months) septorhinoplasty. The control group received routine care. Data were collected with Personal Information Form, Nasal Obstruction Symptom Evaluation (NOSE), and Pittsburgh Sleep Quality Index (PSQI).

FINDINGS

A total of 66.7% of the intervention group and 71.1% of the control group reported that the primary symptom triggering the operation was the inability to breathe through the nose. The intervention group's PSQI and NOSE scale total score averages in the 6th and 12th months after septorhinoplasty were significantly lower than the control group. Correlation revealed a moderate-to-strong and positive correlation between PSQI and NOSE scores.

CONCLUSIONS

Results supported that repetitive training was effective in reducing nasal obstruction symptoms and improving sleep quality in the intervention group compared to the control group.

Functional assessment of septo(rhino)plasty revision surgery

INTRODUCTION

Functional septo(rhino)plasty incurs a 17-25% rate of revision for persistent symptoms.

OBJECTIVES

The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision.

MATERIAL AND METHODS

A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS.

RESULTS

Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P<10-5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P<10-4) and of submucosal resection (P<10-3), while 17% of patients showed no change in scores.

CONCLUSION

Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum.

Common Causes of Failed Septoplasty: A Systematic Review

Failed septal correction is an undesirable outcome of primary septoplasty. In this systematic review, we aimed to assess all current studies concerning septoplasty failure, with a view to identifying its common causes. A systematic literature search was conducted by screening the PubMed, MEDLINE, Embase, and Cochrane Library databases for studies that assessed septoplasty failure and were published between January 2008 and January 2021. Three authors independently extracted information from each study and examined all included articles for bias. Four articles provided pertinent data regarding septoplasty failure. We gathered that missed nasal valve abnormality diagnosis, insufficient separation and resection of the bony-cartilaginous junction, and insufficient correction of caudal septal deviation could cause septoplasty failure. Additionally, iatrogenic problems, nasal asymmetry, and side-wall concavity involving the nasofrontal and columellar labial angles are contributing factors. Determining the cause of nasal blockage is challenging because it is subjective. Based on our findings, we concluded that in all patients with septal deviation, utmost care should be taken to avoid overlooking nasal valve abnormalities and other nasal diseases before conducting septoplasty. Moreover, inadequate correction of caudal septal deviation should be avoided. Furthermore, there is currently no widely accepted classification system for septal abnormalities to measure and describe septal deviation characteristics, making surgical planning and documentation difficult. Hence, further research that would lead to the creation of such a classification system is warranted.

Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics

Purpose

One of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis.

Methods

We collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up.

Results

Altogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery.

Conclusion

The use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account.

A clinical and histopathological comparison of saline, adrenaline and 2-mercaptoethanesulfonate (MESNA) in mucoperichondrial elevation: which is superior?

Objective

To determine whether submucosal mesna (2-mercaptoethane sodium sulfonate) infiltration is superior to normal saline or adrenaline + lidocaine in mucoperichondrial hydrodissection.

Methods

Twenty-one rabbits were administered adrenaline + lidocaine, saline or mesna. Bilateral septal mucoperichondrial flap elevations were performed following submucosal infiltration. The intraoperative bleeding amount, operation time, accessibility of the surgical plane, field quality and degree of mucoperichondrial injury were recorded. The three groups were compared histopathologically.

Results

The amount of bleeding and duration of the operation were significantly higher and the accessibility of the surgical plane score was significantly lower in the saline group vs. the other groups (p < 0.05). The mucosal damage rate was significantly higher in the saline group compared with adrenaline + lidocaine (p < 0.05). The surgical field quality was significantly lower in the saline group compared with adrenaline + lidocaine (p < 0.05). The accessibility of the correct surgical plane score was significantly lower in the saline group compared with the adrenaline + lidocaine and mesna groups (p < 0.05). The amount of bleeding, duration of operation, surgical field quality and accessibility of the surgical plane did not differ significantly between the adrenaline + lidocaine and mesna groups (p > 0.05). The pericondrium thickness was significantly lower in the saline group than the other groups. Cartilage thickness was significantly higher in the saline group compared with the mesna group (p > 0.05).

Conclusion

Use of mesna instead of normal saline or adrenaline + lidocaine in septoplasty was not more advantageous in terms of intraoperative parameters. The adrenaline + lidocaine group was superior to normal saline for all intraoperative parameters. In conclusion, the use of adrenaline may be more advantageous in facilitating septal mucoperichondrium elevation due to its widespread use, low cost and superiority to physiological saline.

Relationship between nasal septum morphology and nasal obstruction symptom severity: computed tomography study

Introduction

The impact of the nasal septum morphology on the severity of obstruction symptoms has not been fully explored.

Objective

This study aimed to investigate whether the morphology of the deviated nasal septum assessed by computed tomography may explain nasal obstruction severity.

Methods

The study included 386 patients who were referred to the computed tomography examination of the paranasal sinuses. Patient selection criteria were the absence of facial anomalies, facial trauma, nasal surgery, and sinonasal tumors. Computed tomography images were used to estimate deviated nasal septum prevalence, the prevalence of Mladina's seven types of deviated nasal septum, and to measure the deviated nasal septum angle. Nasal obstruction severity was assessed by the nasal obstruction symptom evaluation, NOSE scale. The relationship between NOSE score, deviated nasal septum morphology, and deviated nasal septum angle was performed by a statistical regression model on the reduced sample of 225 patients.

Results

The prevalence of deviated nasal septum was 92.7%. Type 7 deviated nasal septum was the most frequent (34.2%) followed by type 5 (26.2%) and type 3 (23.6%). The worst NOSE scores were recorded in the type 2 deviated nasal septum (45.00 ± 28.28). The mean deviated nasal septum angle in patients with nasal obstruction was 8.5° ± 3.24. NOSE scores were not significantly associated with deviated nasal septum types and angles.

Conclusion

Patients with different types of deviated nasal septum have different NOSE scores. Computed tomography morphology of the deviated nasal septum could not fully explain the severity of nasal obstruction.

A prediction modeling based on SNOT-22 score for endoscopic nasal septoplasty: a retrospective study

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.

Septoplasty versus non-surgical management for nasal obstruction in adults with a deviated septum: economic evaluation alongside a randomized controlled trial

BACKGROUND

For years, the benefits of septoplasty have been questioned. Due to the scarce and inconclusive literature, several National Health Service (NHS) Clinical Commissioning Groups in England decided to add septal surgery to their list of restricted procedures with low clinical value. Recently, evidence was obtained that septoplasty is actually more effective than non-surgical management for nasal obstruction in adults with a deviated septum. However, the relation between costs and effects of septoplasty remains unknown.

METHODS

We conducted an economic evaluation alongside an open, multicenter, pragmatic randomized controlled trial in two tertiary and 16 secondary referral hospitals in the Netherlands. Adults with nasal obstruction and a deviated septum were randomized to (1) septoplasty with or without concurrent turbinate surgery or (2) non-surgical management consisting of (a combination of) medical treatment and watchful waiting. Analyses were performed on an intention-to-treat basis. Single imputation nested in the bootstrap percentile method (using 5000 bootstrap replications) was performed to assess the effect of missing data. After 12 and 24 months, we assessed the incremental costs per quality-adjusted life year (QALY) gained from a healthcare and a societal perspective.

RESULTS

A total of 203 adults were randomly assigned to septoplasty (N = 102) or non-surgical management (N = 101). After 12 months, the mean cost difference between septoplasty and non-surgical management using a healthcare or societal perspective was €1181 (95%CI €1038 to €1323) or €2192 per patient (95%CI €1714 to €2670), respectively. The mean QALY difference was 0.03 per patient (95%CI - 0.01 to 0.07). Incremental costs per QALY gained from a healthcare or societal perspective were €41,763 or €77,525, respectively. After 24 months, the mean cost difference between the two groups using a healthcare or societal perspective decreased to €936 (95%CI €719 to €1153) or €1671 per patient (95%CI €952 to €2390), respectively. The mean QALY difference increased to 0.05 per patient (95%CI - 0.03 to 0.14). Incremental costs per QALY gained from a healthcare or societal perspective became €17,374 or €31,024, respectively. Analyses of imputed data did not alter our findings.

CONCLUSIONS

Depending on the selected perspective, cost-effectiveness threshold, and time horizon, septoplasty has the potential to be cost-effective. Despite considerable uncertainty, septoplasty seems to be cost-effective from a healthcare perspective, after 24 months against a threshold of €20,000 per QALY. From a societal perspective, septoplasty is not yet cost-effective after 24 months, but it comes closer to the cost-effectiveness threshold as time passes by.

TRIAL REGISTRATION

Nederlands Trial Register, NTR3868 (https://www.trialregister.nl/trial/3698). Prospectively registered on February 21, 2013.

Association Between Nasal Obstruction Symptoms and Anxiety

AIM

The aim of this study was to determine the correlation between nasal function assessment and anxiety scales.

METHODS

A total of 120 patients with the complaint of nasal obstruction were classified as nasal septum deviation group (DNS) and no nasal pathology group (NON). A control group was formed of 57 healthy participants. Nasal obstruction severity was assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, nasal resistance level with rhinomanometry and anxiety levels with the Agoraphobic Cognitions Questionnaire (ACQ), and the Body Sensations Questionnaire (BSQ).

RESULTS

There was a statistically significant difference between both the DNS and the NON groups and control group in terms of NOSE scale, ACQ, and BSQ (P < .001). The total nasal resistance values were higher in the DNS group compared to both the NON and control groups (P < .001), although the difference between the NON group and control group was not statistically significant.

CONCLUSION

The results of this study showed that patients with nasal breathing complaints, but no organic pathology, had the same level of nasal obstruction symptoms as patients with nasal septal deviations. Anxiety levels are elevated in patients with symptoms of nasal obstruction, even when there is lack of organic nasal pathology.

Is Computed Tomography Imaging of Deviated Nasal Septum Justified for Obstruction Confirmation?

Third-party payers request objective confirmation of the nasal septum deviation (NSD) severity by computed tomography (CT) before authorizing financial support for septoplasty. Previous studies have provided contradictory results related to the link between obstruction severity and CT-measured angle of the NSD. The aim of this study was to investigate whether the diverse CT morphology of NSDs (including previously neglected types and shapes) could predict obstruction severity. The study included 225 patients with NSD. The CT morphology of the septum was analyzed using 5 different classifications of NSD that are commonly used in the clinical practice and research. The angle of NSD was also measured. Nasal obstruction was assessed by the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. A relationship between CT morphology and the angle of the NSD and NOSE scores was analyzed using appropriate regression models. Patients with NSDs located in the anterior part of the septum always have some degree of nasal obstruction, while those with posterior NSDs did not necessarily report obstruction symptoms no matter how complicated NSD they have. Regression analysis did not reveal any causal relationship between NOSE scores and CT morphology and the angle of NSD. The presence of spurs and whether they divide nasal passages have no statistically significant predictive effect on the obstruction severity. The CT morphology and the angle of the NSD could not predict severity of the nasal obstruction. Requesting CT examination just to objectively confirm nasal obstruction is not justified.

Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial

BACKGROUND

Septoplasty (surgical correction of the deviated nasal septum) is the most frequently performed ear, nose, and throat operation in adults, but no randomised controlled trials or non-randomised comparative studies on the effectiveness of septoplasty have been published. Consequently, health-care providers, health insurance companies, and policy makers are concerned about the effectiveness of the procedure. We aimed to assess the effectiveness of septoplasty for nasal obstruction in adults with a deviated septum.

METHODS

We did this open, multicentre, pragmatic, randomised controlled trial in 16 secondary and two tertiary referral hospitals in the Netherlands. Adults (aged ≥18 years) with nasal obstruction, a deviated septum, and an indication to have septoplasty done were randomly allocated (1:1) to receive either septoplasty with or without concurrent turbinate surgery or non-surgical management. Patients were stratified by sex, age (<35 years or ≥35 years), and deviation severity (mild, moderate, or severe). The primary outcome was health-related quality of life, measured with the validated Glasgow Health Status Inventory at 12 months. Analyses were done on an intention-to-treat basis. The trial is registered with the Netherlands Trial Register, number NTR3868.

FINDINGS

Between Sept 2, 2013, and Dec 12, 2016, we randomly assigned 203 participants to receive either septoplasty with or without concurrent turbinate surgery (n=102) or non-surgical management (n=101). 189 participants were analysed at 12 months. At 12 months, mean score on the Glasgow Health Status Inventory of patients assigned to septoplasty was 72·2 (SD 12·2) and for those assigned to non-surgical management was 63·9 (SD 14·5, mean difference 8·3 [95% CI 4·5-12·1], favouring septoplasty). Septal abscess occurred in one surgical patient and septal perforation in two surgical patients. No side-effects of nasal medication were reported.

INTERPRETATION

Septoplasty is more effective than non-surgical management for nasal obstruction in adults with a deviated septum. This effect was sustained up to 24 months of follow-up.

FUNDING

The Netherlands Organisation for Health Research and Development (ZonMw).

Intranasal endoscopic identification of the nasal septal L-strut: a cadaveric study

BACKGROUND

Preserving the L-shaped strut during septoplasty is a crucial step in the prevention of several types of postoperative nasal deformities. In this study, we aimed to identify the intranasal anatomic landmarks to establish reliable and feasible measurements to preserve an adequate L-strut during an endoscopic septoplasty.

METHODS

A prospective study was conducted on 20 cadaver heads. Three measurements were studied within each side of the nasal cavity. The dorsal strut (DS) was measured from the dorsal line to the septal dorsum edge. Then, the caudal strut was measured from 2 different landmarks: the axilla of the inferior turbinate (CSIT) and the pyriform aperture (CSP).

RESULTS

We examined a total of 40 nasal cavities from 20 cadavers. The DS showed an average length of 15.1 mm (standard deviation [SD], 3.2 mm). The average lengths of the CSIT and CSP were 23.6 (SD, 3.6) mm and 19.4 (SD, 2.7) mm, respectively.

CONCLUSION

Suggested landmarks to identify the dorsal and caudal struts in endoscopic septoplasty are the axilla of the middle turbinate and pyriform aperture bone, respectively. The utilization of the inferior turbinate axilla as a caudal strut landmark showed larger variability and would potentially leave excessive caudal cartilage that could be manipulated if deviated.

A Novel Approach to Septal Perforation Repair: Septal Cartilage Cells Induce Chondrogenesis of hASCs In Vitro

The aim of this study was to investigate the effect of medium harvested from septal cartilage cells on chondrogenic differentiation of adipose stem cells (hASCs) and to compare/contrast its properties to those of a commonly used standard medium formulation in terms of induction and maintenance of chondrogenic hASCs. Differentiation was carried out under three different conditions: septal cartilage medium-SCM, chondrogenic differentiation medium-CM, and 50:50 mixture of CM/SCM. Mesenchymal stem cells (MSCs) markers were determined by flow cytometry. The cytotoxic and apoptotic effects were determined by MTS and Annexin V assay, respectively. The differentiation status of the cells was confirmed by Alcian blue staining, and quantitative real-time flow cytometry showed that hASCs were positive for MSCs, negative for hematopoietic stem cells and endothelial cell surface markers. According to MTS analysis, the first condition was not toxic at any concentration tested. Annexin V assay revealed that the application of different concentrations of SCM did not result in any cell death. The Alcian blue and gene expression analyses showed that the cells in the SCM group underwent the highest cartilage cell formation. The observed increase in chondrogenesis may offer better treatment options for the cartilage defects seen in nasal septum perforation.

Septoplasty versus non-surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost-effectiveness

OBJECTIVE

The objective of this study was to demonstrate how decision-analytic modelling can help to determine circumstances under which surgery may become cost-effective, using septoplasty as an example.

DESIGN

We developed a decision-analytic model comparing septoplasty to non-surgical management for nasal obstruction in adults with a deviated septum. Based on the estimated cost difference between both treatments, we calculated the minimal (a) gain in quality-adjusted life-years, or (b) reduction in productivity losses needed for septoplasty to be cost-effective. Input was derived from literature and publicly available data sources. The time horizon of our model was one year, and the willingness-to-pay per quality-adjusted life-year was €20 000, in accordance with current guidelines.

RESULTS

The cost difference between septoplasty and non-surgical management for nasal obstruction due to a deviated nasal septum was €2227 per patient from a healthcare perspective (including direct healthcare costs) and €3288 per patient from an extended perspective (additionally including travel expenses and productivity losses due to poor health). In comparison with non-surgical management, septoplasty needed to gain 0.11 to 0.16 QALYs or save 13 sick days for nasal obstruction. The longer septoplasty's effect lasts, the more time it will have to compensate its extra costs.

CONCLUSION

This study shows that the known cost difference between treatments can be used as the starting point to determine beneficial effects needed for cost-effectiveness of surgical interventions. The effect required by septoplasty from a healthcare perspective seems potentially achievable, meaning that it would be useful to perform an RCT assessing the actual benefits of septoplasty.

The Impact of Septal Deviation on Intranasal Schirmer Test Values

Objective

Intranasal Schirmer test serves as an objective measurement for evaluation of nasal secretion and humidity. This study aimed to evaluate the effect of septal deviation on nasal secretion and humidity by measuring the intranasal Schirmer test values in patients who had septal deviation and compare it to the values of our healthy volunteers.

Methods

The study included 52 patients with nasal septum deviation and 52 volunteers without any rhinologic complaints or deviated nasal septum. Intranasal Schirmer test was performed to all patients and volunteers for both nasal cavities.

Results

The intranasal Schirmer test values of the convex (deviated) side were lower than that of the concave (non-deviated) side (20.71 and 23.35 respectively); although this difference was not statistically significant (p=0.054,). After excluding the four patients with equal Schirmer test results on both sides, 70% (34/48) of our patients had lower intranasal Schirmer test values on the deviated side. There was no statistically significant difference between the Schirmer test values of the patients with septal deviation and the volunteers without septal deviation (p>0.05).

Conclusion

The Schirmer test values of the deviated sides were less than the values of the contralateral side in majority of our patients. This finding supports the negative effect of nasal septum deviation on nasal humidification, although the difference did not reach statistical significance.

Long-term patient-related outcome measures of septoplasty: a systematic review

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.

Determining a Successful Nasal Airway Surgery: Calculation of the Patient-Centered Minimum Important Difference

Objective Determine whether the patient-identified minimum important difference (MID) in Nasal Obstruction Symptom Evaluation (NOSE) score differs from a statistically calculated estimate of MID in patients with septal deviation undergoing nasal airway surgery. Study Design Prospective cohort. Setting Tertiary academic referral center. Subjects Patients with nasal obstruction due to septal deviation. Methods Patients completed the NOSE questionnaire preoperatively and indicated the change from their baseline score that they would consider the minimum improvement required to define the septoplasty with turbinate reduction as successful. A previously published distribution-based approach was used to estimate the MID based on baseline NOSE scores. Scores were reported both as a raw score and as a percentage of patients' baseline scores. One-sample t test was used to compare the statistically estimated MID to the patient-reported MID. Results Seventy-six patients were included. The mean (SD) baseline NOSE score was 12.9 (4.03). The mean (SD) patient-identified MID was 5.3 (2.1), corresponding to a 41.1% change (95% confidence interval, 37.2-41.3) from baseline. The statistically estimated MID was 5.2 points (40.3% reduction from baseline scores). The estimated MID was not significantly different from the patient-identified MID ( P = .4). Conclusion In patients with septal deviation, an improvement of approximately 40% in their nasal obstructive symptoms as assessed by the NOSE questionnaire is required to define a nasal airway surgery as successful. The patient-identified and the statistically calculated MIDs were similar. Furthermore, this MID can be used to guide research, improving the ability to use the NOSE score as a dichotomous scoring measure (treatment success/failure) and estimating sample size.

Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

BACKGROUND

Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. The aim of our study was to evaluate the relationship between the direction and degree of nasal septal deviation with nasal bone morphology, along with factors such as age and gender.

METHODS

Maxillofacial computed tomography (CT) of 250 patients with nasal septal deviation was analyzed retrospectively in this study. We excluded patients with factors that could affect their nasal bone morphology, and a total of 203 patients (111 males, 92 females; mean age, 36.23 years; age range, 18-79 years) were evaluated. The nasal deviation angle was measured on coronal CT images as the angle between the most deviated point of the septum, and the midline nasal morphology was determined by measuring nasal length, internasal angle and lateral and intermediate nasal thickness on both sides.

RESULTS

The deviation of nasal septum has been detected as to the right in 107 patients (52.7%) and to the left in 96 patients (47.3%). Lateral and intermediate nasal bone thickness and nasal bone length were significantly greater on the ipsilateral deviation side (Table 3). No significant correlation was found between the variation of the nasal deviation angle and nasal bone morphology (Table 4). There were significant differences between the sexes for all investigated parameters except for the nasal deviation angle (p = 0.660). We found that the only internasal angle increases with aging (p = 0.002).

CONCLUSION

The study shows that the direction of nasal septal deviation may be a factor that affects nasal bone morphology.

Quality of Life Changes Following Concurrent Septoplasty and/or Inferior Turbinoplasty During Endoscopic Pituitary Surgery

OBJECTIVE

Endoscopic endonasal transsphenoidal surgery (EETS) is a widely accepted technique for sellar tumors. Common findings during preoperative assessment include septal deviations and turbinate hypertrophy. This study evaluated quality of life changes after concurrent septoplasty and/or inferior turbinoplasty during EETS.

METHODS

A retrospective review was performed of a prospectively collected database including all patients undergoing EETS at our institution during a 10-month period between 2015 and 2016. Patients were divided into a septoplasty/inferior turbinoplasty group and a no septoplasty/inferior turbinoplasty group. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate quality of life. Mean preoperative scores were compared with 1- and 3-month postoperative scores within each cohort. The SNOT-22 was also reorganized into 5 distinct subdomains. Average subdomain scores were calculated, and preoperative and 1- and 3-month postoperative subdomain scores were compared within each cohort. A paired Student t test was used. P values < 0.05 were considered statistically significant.

RESULTS

All 24 patients met inclusion criteria by completing preoperative and postoperative SNOT-22 surveys. In the septoplasty/inferior turbinoplasty group, preoperative and 3-month postoperative scores showed a clinically significant difference (P = 0.047). The septoplasty/inferior turbinoplasty group specifically showed a significant difference in the psychiatric and sleep SNOT-22 subdomains when comparing preoperative with 3-month postoperative scores (P = 0.03, P = 0.01).

CONCLUSIONS

Patients who underwent concurrent septoplasty and/or turbinoplasty with EETS had a significantly improved quality of life compared with preoperative assessment, specifically regarding psychological and sleep symptoms.