Assessment of symptom improvement following nasal septoplasty with or without turbinectomy

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Abstract

Most studies show that objective measures to quantify and determine surgical success in the treatment of nasal obstruction do not correlate with subjective improvement as reported by patients.

Aim

To evaluate the subjective improvement of nasal symptoms in patients undergoing septoplasty with or without turbinectomy.

Materials and methods

A prospective study. We evaluated 72 septoplasty patients with or without partial inferior turbinectomy; the patients answered a questionnaire preoperatively and on the 60th day after surgery.

Results

Septoplasty was done associated with bilateral partial inferior turbinectomy in 83.3% of patients; it was unilateral in 9.7%; there was no need for turbinate reduction in 6.9%. An improvement of all symptoms was observed after surgery. Nasal obstruction had improved in 68 patients (94.4%) by the 60th postoperative day. The average nasal obstruction score in patients with and without allergic symptoms was similar before surgery and on the 60th postoperative day. Older patients had milder preoperative allergic symptoms.

Conclusions

Nasal symptoms in patients undergoing septoplasty, with or without turbinectomy, improved. Patients with and without allergic symptoms showed a similar improvement of nasal obstruction on the 60th postoperative day.

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Most cited references 36

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Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study.

D L Witsell, Jonas T Johnson, Michael K G Stewart … (2004)

Our goal was to assess disease-specific quality of life outcomes after nasal septoplasty in adults with nasal obstruction. We conducted a prospective observational outcomes multicenter study with 14 sites and 16 investigators, including private practice and academic settings. Patients had had septal deviation and symptomatic nasal obstruction for at least 3 months, and medical management had failed. Patients with septal deviation completed a validated outcomes instrument (the Nasal Obstruction Septoplasty Effectiveness [NOSE] scale) before and 3 and 6 months after septoplasty, with or without partial turbinectomy. Fifty-nine patients underwent surgery; there was a significant improvement in mean NOSE score at 3 months after septoplasty (67.5 versus 23.1, P < 0.0001), and this improvement was unchanged at 6 months. Patient satisfaction was very high, and patients used significantly fewer nasal medications. In patients with septal deformity, nasal septoplasty results in significant improvement in disease-specific quality of life, high patient satisfaction, and decreased medication use.

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

R. Andre, H D Vuyk, A. Ahmed … (2009)

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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Long term results following nasal septal surgery. Focus on patients' satisfaction.

Athanasios Triaridis, Iordanis E Konstantinidis, George Kontzoglou … (2005)

The patient selection for septoplasty usually relies on clinical judgement alone. It is not clear, if surgeons' selection criteria are able to accurately anticipate patients' long term satisfaction as only a few studies exist on the outcome of nasal septal surgery. In this study, we analyze patients' long term satisfaction following septoplasty based on their subjective opinion. In this prospective study, 67 consecutive patients, who underwent septoplasty during one year in a District General Hospital, were included. We used the fairley nasal symptom questionnaire (FNQ) preoperativeiy and postoperatively and the Glasgow benefit inventory (GBI) postoperatively to assess the outcome. Patients were mailed two questionnaires 2-3 years postoperatively, to evaluate their perception of the procedure's long term results. As a criterion to measure the success of the operation we used the median postoperative FNQ score and patients were divided into two groups, consisting of patients with more and less successful result, respectively. Fifty-one patients responded (76%). Analysis of the outcomes revealed significant improvement of total nasal symptom score (FNQ) postoperatively (from mean score 13.25 to 9.09) with significant benefit in the nasal obstruction, sore throat and the sense of smell but not for headaches. Significant improvement in nasal breathing was recorded mainly from patients with anterior septal deviation. Patients in the below criterion group (49%) had a mean GBI total score of 6.3, reporting no satisfaction after surgery, whereas patients in the above criterion group (51%) had a mean of 23.8, which is also not a satisfactory result. Social and physical components of GBI had no difference between groups having considerably low scores. The principal benefits of septal surgery are related to improvement in nasal symptoms. In this study GBI results did not reflect a significant change in health status from septoplasty even in the above criterion group. The significant percentage of patients who did not report satisfaction in the long term, questions the objectivity of surgeons' criteria regarding nasal septal surgery. It also indicates that positive evaluation by patients of septal surgery outcome tends to be attenuated with time.

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Author and article information

Journal

Journal ID (nlm-ta): Braz J Otorhinolaryngol

Journal ID (iso-abbrev): Braz J Otorhinolaryngol

Title: Brazilian Journal of Otorhinolaryngology

Publisher: Elsevier

ISSN (Print): 1808-8694

ISSN (Electronic): 1808-8686

Publication date PMC-release: 22 October 2015

Publication date Collection: Sep-Oct 2011

Publication date (Electronic): 22 October 2015

Volume: 77

Issue: 5

Pages: 577-583

Affiliations

[1 ]Medical resident (R3) at the Otorhinolaryngology Unit, HSPM

[2 ]Medical resident (R3) at the Otorhinolaryngology Unit, HSPM

[3 ]Doctoral degree in sciences, São Paulo Federal University. Post-doctoral degree, São Paulo Federal University. Assisting physician of the Otorhinolaryngology Unit, HSPM

Author notes

[* ]Send correspondence to: Leandro Castro Velasco - Rua Antônio Alves Martins, 150 - Bairro Lucilene - Santa Helena de Goiás, GO. CEP: 75920-000

Article

Publisher Item ID: S1808-8694(15)30701-1

DOI: 10.1590/S1808-86942011000500007

PMC ID: 9443779

PubMed ID: 22030964

SO-VID: 9ce0410b-ac18-4e8d-9b19-d743b2d17152

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Assessment of symptom improvement following nasal septoplasty with or without turbinectomy

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Abstract

Abstract

Aim

Materials and methods

Results

Conclusions

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Most cited references 36

Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study.

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

Long term results following nasal septal surgery. Focus on patients' satisfaction.

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