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      Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction using Objective and Subjective Methods

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          Abstract

          Introduction  Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely.

          Objective  The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients.

          Methods  This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36 months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL.

          Results  There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased.

          Conclusion  The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.

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          Most cited references31

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

          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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            Consensus report on acoustic rhinometry and rhinomanometry.

            With respect to acoustic rhinometry, new elements concern the problems related to the interpretation of the minimal cross-sectional area, and the presentation of a protocol for a multinational study, which aims to define a normal nose. Also, the previously issued recommendations for standardisation for technical specifications and standard operating procedures are briefly reviewed. For rhinomanometry, new insights into the field of fluid dynamics are highlighted, as well as their repercussion on more recent graphical representations for active anterior rhinomanometry such as four phases rhinomanometry and resistometry. For acoustic rhinometry as well as rhinomanometry, a more stringent standardisation of decongestive procedures is suggested.
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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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                Author and article information

                Journal
                Int Arch Otorhinolaryngol
                Int Arch Otorhinolaryngol
                10.1055/s-00025477
                International Archives of Otorhinolaryngology
                Thieme Revinter Publicações Ltda (Rio de Janeiro, Brazil )
                1809-9777
                1809-4864
                July 2018
                18 January 2018
                : 22
                : 3
                : 284-290
                Affiliations
                [1 ]Department of Otorhinolaryngology, Georgios Gennimatas General Hospital, Thessaloniki, Greece
                [2 ]1st University Department of Otorhinolaryngology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [3 ]2nd University Department of Otorhinolaryngology, Geniko Nosokomeio Thessalonikis Papageorgiou, Thessaloniki, Greece
                Author notes
                Address for correspondence Konstantinos Valsamidis, MD, MSc Department of Otorhinolaryngology, Georgios Gennimatas General Hospital Ethinikis Amynis 41 Thessaloniki 54635Greece kosvals@ 123456hotmail.com
                Article
                0670or
                10.1055/s-0037-1613688
                6033599
                29983770
                f9a237eb-1a5c-45ba-8b56-c0ca5adfce1e

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 30 April 2017
                : 30 September 2017
                Categories
                Original Research

                nasal obstruction,septoplasty,acoustic rhinometry,quality of life

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