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      Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation Translated title: Efficacia della settoplastica endoscopica nei vari tipi di deformità settale: la nostra esperienza con il questionario NOSE


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          Septal deviations are the most frequent cause of nasal obstruction, and represent a common complaint in rhinologic practice. Since the first description of Lanza et al. in 1991, the use of the endoscope for the correction of septal deformities is increasingly more frequent. The purpose of this study is to evaluate the effectivenes of the endoscopic septoplasty for the correction of each of the 7 types of septal deformities according to the Mladina’s classification. A retrospective chart review was performed in 59 consecutive patients presenting to our Department for Endoscopic Septoplasty from February 2012 to August 2014. For each deviation, descriptive statistics (mean and standard deviation, significant increase/decrease) was used to asses the corrective capacity and time-dependent effects at follow-up. This study shows that the corrective power of endoscopic septoplasty is different according to the type of deviation.

          To our knowledge this is the first study that evaluates the corrective capacity of this technique for each deviation by analysing pre- and postoperative objective outcomes as well as subjective outcomes gathered from the validated NOSE questionnaire. Even if endoscopic septoplasty may now be considered a reliable alternative to the classic technique, it is essential to identify the right deformity preoperatively in order to provide the correct therapeutic choice.


          Le deviazioni del setto sono la causa più frequente di ostruzione nasale e rappresentano un problema comune nella pratica rinologica. L’uso dell’endoscopio per la correzione delle deformità del setto dalla prima descrizione di Lanza et al. nel 1991 ad oggi è sempre più frequente. Lo scopo di questo studio è quello di valutare l’efficacia della settoplastica endoscopica per la correzione di ciascuno dei 7 tipi di deformità del setto secondo la classificazione di Mladina. Una revisione retrospettiva è stata eseguita in 59 pazienti che si sono presentati presso il nostro Dipartimento per essere sottoposti a settoplastica endoscopica da febbraio 2012 ad agosto 2014. Per ogni deviazione, è stata effettuata un’analisi statistica descrittiva (media e deviazione standard, aumento/ diminuzione significativa) al fine di valutare la capacità correttiva e gli effetti al follow-up. Questo studio ha dimostrato che il potere correttivo della settoplastica endoscopica è diverso a seconda del tipo di deviazione. Questo è il primo studio che valuta la capacità di correzione di questa tecnica per ogni deviazione, analizzando i risultati oggettivi pre e post-operatori, nonché gli esiti soggettivi raccolti dal questionario NOSE. Anche se la settoplastica endoscopica può essere considerato ora una alternativa affidabile alla la tecnica classica è essenziale identificare preoperatoriamente il tipo di deformità al fine di fornire la corretta scelta terapeutica.

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          Most cited references27

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          Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence.

          There is no consensus about the value of objective measurements of nasal patency. To assess the correlation between the subjective sense of nasal patency and the outcomes found with rhinomanometry and acoustic rhinometry. Structured literature search. SEARCH STRATEGY AND EVALUATION METHOD: Review of English-language articles in which correlations were sought between subjective nasal patency symptoms and objective scores as found with rhinomanometry [nasal airway resistance (NAR)] and acoustic rhinometry [minimal cross-sectional area (MCA)]. Correlations were related to unilateral or combined assessment of nasal passages and to symptomatic nasal obstruction or unobstructed nasal breathing. Sixteen studies with a level of evidence II-a or II-b fit the inclusion criteria and were further analysed. Almost every possible combination of correlations or lack thereof in relation to the variables included was found. However, when obstructive symptoms were present, a correlation between the patency symptoms with nasal airway resistance and minimal cross-sectional area was found more often than in the absence of symptoms. In cases of bilateral assessment a correlation was found almost as often as it was not between patency symptoms and total nasal airway resistance or combined minimal cross-sectional areas, while in the limited amount of studies in which unilateral assessment was done a correlation was found each time between patency symptoms and nasal airway resistance. The correlation between the outcomes found with rhinomanometry and acoustic rhinometry and an individual's subjective sensation of nasal patency remains uncertain. Based on this review, it seems that the chance of a correlation is greater when each nasal passage is assessed individually and when obstructive symptoms are present. There still seems to be only a limited argument for the use of rhinomanometry or acoustic rhinometry in routine rhinologic practice or for quantifying surgical results.
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            The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation.

            The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation (NOSE) scale for septoplasty (without turbinate reduction) in comparison with other examination methods. Prospective observational study was undertaken in otolaryngology department of university hospital. NOSE scale for quality of life assessment, visual analog scale for examination findings, acoustic rhinometry and coronal computed tomography were performed before and after septoplasty. The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed. Twenty-seven patients underwent septoplasty; there was a very significant improvement in mean NOSE scores of patients (60.2 versus 11.28, p<0.01). There was no correlation between NOSE scores and acoustic rhinometry. Correlation was found between NOSE scores and examination and computed tomography findings (p<0.05). NOSE scale that is well correlated with examination findings and computed tomography, is very useful tool to evaluate the effectiveness of pure septoplasty. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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              Nasal septal deformities in ear, nose, and throat patients: an international study.

              The purpose of this study was to investigate the incidence and characteristics of nasal septum deformities in ear, nose, and throat (ENT) patients in various geographic regions in the world. Anterior rhinoscopy without nasal decongestion was performed in 17 ENT centers in 14 countries. The septal deformities were classified according to the classification system proposed by Mladina. A total of 2589 adult ENT patients (1500 males and 1089 females) were examined. Septal deformities were found in 89.2% of subjects. Left-sided deformities were slightly more prevalent than right-sided deformities (51.6% and 48.4%, respectively). The most frequent type of deformity was type 3 (20.4%). Straight septum was found in 15.4% of females and 7.5% of males. Almost 90% of the subjects showed 1 of the 7 types of septal deformity. There were no statistically significant differences in the incidence of their appearance among particular geographic regions. Type 3 was the most frequent type. Straight septum was twice as frequent in females than in males.

                Author and article information

                Acta Otorhinolaryngol Ital
                Acta Otorhinolaryngol Ital
                Acta Otorhinolaryngologica Italica
                Pacini Editore Srl
                August 2018
                : 38
                : 4
                : 323-330
                [1 ] Department of Maxillofacial Surgery, University of Naples Federico II , Naples, Italy
                [2 ] Department of Otorhinolaryngology, University of Naples SUN , Naples, Italy
                [3 ] Department of Economy and Business, University of Sannio , Benevento, Italy
                [4 ] Department of Neurosurgery, University of Salerno , Italy
                Author notes
                Address for correspondence: Giovanni Salzano, Department of Maxillofacial Surgery, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy. Tel. +39 081 7462176. E-mail: giovannisalzanomd@ 123456gmail.com

                * Present address: Department of Otorhinolaryngology, University Luigi Vanvitelli of Naples, Italy

                Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

                : 27 January 2016
                : 06 June 2017
                Page count
                Figures: 4, Tables: 3, Equations: 0, References: 28, Pages: 8

                endoscopic septoplasty,septal deviation,nose scale,septal deformities,cottle‘s area,settoplastica endoscopica,deviazione settale,deformità settale,area di cottle


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