The correlation of computed tomography in the evaluation of septoplasty patients

Association Between Anterior Rhinoscopic/Endoscopic Assessment of Internal Nasal Valve and Various Nasal Deformities in the Rural Population of Vidarbha Region of India: A Cross-Sectional Study

Background The nasal valves constitute the majority of the nasal cavity's resistance. Any reduction in this already narrow area can cause a significant reduction in the nasal airflow. In this present study, the aim was to do an endoscopic assessment of the internal nasal valve (INV) in patients with various nasal septal deviations, with or without external nasal deformity. We measured endoscopically the INV in various nasal deformities and derived its association with the INV on anterior rhinoscopy and endoscopic assessment. Method  We included 75 patients in the study who were analyzed for angle and grade of the INV by anterior rhinoscopic examination and Hopkins rod zero-degree nasal endoscope (Karl Storz SE & Co., Tuttlingen, Germany). Nasal septal deviations were also studied with respect to the Mladina classification. Correlation between various nasal septal deviations with the INV was done. Since studies addressing the classification of INV are not available in the literature, for the purpose of simplification of observation of INV angle, (normal range 9-15 degrees), subjective stratification was made in the study, i.e. below 9, 9-15, and more than 15 degrees for the sake of knowing the underlying cause and its relationship. Result An anterior rhinoscopic examination was performed on 75 patients. INV Grade 1 was the most common, with 18 patients of (69.2%), 15 patients of DNS with caudal dislocation (55.6%), five patients of DNS with spur (38.5%), and four patients of DNS with external nasal deformity (50%). The next frequently observed Grade of INV on anterior rhinoscopy examination was Grade 2, in 11 patients of DNS with caudal dislocation (40.7%), four patients of DNS with spur (30.8%), and three patients of DNS with external deformity (37.5%), which was statistically significant in our study. In the majority of patients with all types of nasal septal deviations with or without external nasal deformity, INV (angle) of less than 9 degrees was noted, which was statistically significant. A linear relationship, ie., Grade 0 INV in Type I, Grade 1 INV in types II, III, IV, and V, and Grade 2 in Type VII was observed. Our study is on par with the literature questioning the dogma of the normal angle of INV being 9-15 degrees. Conclusion We were able to establish a positive and complimentary role of anterior rhinoscopic and endoscopic assessment of INV. The proposed novel classification of the angle of INV by endoscopic assessment gives a better insight into the association of INV with various nasal septal deformities with or without external nasal septal deviation.

Postoperative Curative Effect of Cardiac Surgery Diagnosed by Compressed Sensing Algorithm-Based E-Health CT Image Information and Effect of Baduanjin Exercise on Cardiac Autonomic Nerve Function of Patients

This research was aimed at exploring the effect of CT images reconstructed by optimized compressed sensing algorithm on postoperative diagnosis of patients with hypertensive heart disease and the influence of Baduanjin on cardiac autonomic nerve function. Based on the compressed sensing algorithm, the maximum likelihood expectation maximization algorithm was introduced to optimize it, and the optimization algorithm was established. The optimized algorithm and filtered back projection algorithm (FBP) were compared regarding the root mean squared error (RMSE), peak signal-to-noise ratio (PSNR), and structural similar image metric (SSIM). A total of 126 patients with hypertensive heart disease who underwent CT examination in the hospital were selected as study subjects. According to whether Baduanjin intervention was adopted, patients were divided into observation group (conventional treatment +Baduanjin) and control group (conventional treatment), with 63 patients in each group. The effect of CT examination on postoperative diagnosis was analyzed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), differential pressure (DP), respiratory rate and heart rate (HR), very low-frequency (VLF) power, low-frequency (LF) power, high-frequency (HF) power, total power (TP) of HR variability, and changes in LF/HF of patients before and after treatment were compared. The RMSE of the compressed sensing optimization algorithm (3.28 ± 0.36) was significantly lower than that of the FBP algorithm (9.25 ± 1.03) (P < 0.05). The SSIM and PNSR of the compressed sensing optimization algorithm were (0.87 ± 0.10) and (21.22 ± 1.60) dB, respectively. The SSIM was significantly higher than the FBP algorithm (P < 0.01), and the PNSR was also higher than the FBP algorithm (P < 0.05). The detection rate of CT for pleural effusion was 16 cases (25.40%) higher than 5 cases (7.94%) with TTE (P < 0.01). After treatment, SBP, DBP, HR, LF, VLF, LF/HF, and DP values in the observation group were lower than those in the control group (P < 0.05), and TP and HF were higher than those in the control group (P < 0.05). It suggested that a novel algorithm was established based on compressed sensing algorithm to improve image quality. CT image had important guiding significance for postoperative diagnosis of heart. Baduanjin intervention could improve the integrated function of patient's autonomic nervous system and the regulation ability of the vagus nerve.

Mouth breathing – A predictor for patient satisfaction after nasal septoplasty?

Background: No reliable marker exists to predict septoplasty outcome. Most patients suffering from nasal airway obstruction (NAO) caused by a deviation of the nasal septum report a bothersome mouth breathing and dryness. In this study our aim was to assess, whether mouth breathing could be objectified in these patients and whether mouth breathing could predict septoplasty outcome. Methods: A monocentric, prospective case-control study of 21 patients was conducted. The proportion of mouth breathing was measured in a blinded manner. As a measurement of patient satisfaction, subjective symptoms pre- and postoperatively, were assessed by using VAS, NOSE and SNOT-20 score. In the patient group an additional acoustic rhinometry and a clinical examination of the nose were performed. Results: With a mean of 25% (SD = 20%) the proportion of mouth breathing in patients with NAO did not differ significantly from the proportion in controls without NAO, with a mean of 27% (SD = 23%). Analysis of subjective scores revealed a significant reduction of subjective symptoms after septoplasty. A higher preoperative proportion of mouth breathing correlated with more remaining postoperative NAO. Conclusions: The percentage of mouth breathing is no different in patients with symptomatic septal deviation than in control patients. Mouth breathing in patients with NAO, evaluated for septoplasty, could be a negative predictive factor for patient satisfaction after nasal septoplasty. Mouth breathing in these patients should be observed carefully because more preoperative mouth breathing should make one more hesitant to consider septoplasty.

Objective evaluation of caudal deviation of the nasal septum and selection of the appropriate septoplasty technique

OBJECTIVE

Several methods have been reported to correct caudal deviation of the nasal septum, including open septorhinoplasty (OSR) and septoplasty with Killian incision (KI). In general, OSR is applied instead of KI for caudal deviation. However, there is little objective evidence own on the effects of OSR and KI for caudal deviation. In this study, we compared surgical outcomes between OSR and KI by quantifying nasal septum deviation using two simple and objective parameters on routine paranasal sinus CT scans.

METHODS

We retrospectively analyzed 18 patients who underwent OSR and 11 patients who underwent septoplasty with KI between April 2006 and October 2019. Caudal deviation was defined on the basis of the "Anterior-posterior Position of the most deviated point of the nasal septum (AP)," which was measured on computerized tomography. The deformation rate (DR) of the nasal septum was also calculated. Nasal airway resistance and visual analogue scale (VAS) score for nasal obstruction were examined.

RESULTS

The AP was significantly correlated with the VAS score (r=-0.58, p=0.017). The DR in patients with caudal septal deviation was significantly decreased by OSR (0.14±0.06 to 0.03±0.03, p=0.004), but not by KI (0.09±0.08 to 0.04±0.03, p=0.25). OSR also improved nasal airway resistance (1.10±0.44 to 0.42±0.15, p=0.02), and the VAS score (79.11±14.74 to 5.78±7.89, p=0.004).

CONCLUSION

Nasal obstruction is more severe in patients with the caudal deviation. OSR corrects caudal deviation of the nasal septum more effectively than does KI. The AP could be useful for the evaluation of the deviation of the nasal septum and help in selecting the appropriate septoplastic technique.