Nasal septal surgery: evaluation of symptomatic and general health outcomes.

Although septoplasty and submucous resections are common procedures, there have been very few studies on the outcome of nasal septal surgery. This prospective study of two hundred patients undergoing septal surgery used the Fairley nasal symptom score, the Nottingham health profile, a general health questionnaire and clinical examination of nasal cavities to assess the outcome. A wide range of baseline severity scores was observed. Almost 40% of patients failed to attend for review. Analysis of the outcomes in the remaining 121 patients revealed significant improvement in (a) nasal obstruction in 74%, (b) facial pain in 72%, and (c) catarrh in 64% of patients. There was a lack of correlation between observed postoperative reduction in the number of nasal septal areas deviated and improvement in nasal obstruction. The Nottingham health profile and general health questionnaire scores remained unchanged in a large majority of patients. Postoperative improvement in nasal obstruction was independent of grade of surgeon or concomitant lateral nasal wall surgery. The principal benefits of septal surgery relate to improvement in nasal symptoms. The generic quality-of-life measures such as the Nottingham health profile and general health questionnaire did not show significant improvement in quality of life. Our results support the use of disease-specific instruments to evaluate the outcome of septal surgery.     

Can the Sino‐nasal Outcome Test (SNOT‐22) be used as a reliable outcome measure for successful septal surgery?

Can the Sino‐nasal Outcome Test (SNOT‐22) be used as a reliable outcome measure for successful septal surgery? Septoplasty and submucous resection are common procedures in the UK. This study looks prospectively at 40 patients undergoing surgery at two hospitals. A pre‐ and postoperative assessment (3 months) was made using the Sino‐nasal Outcome Test. This test was originally designed for rhinosinusitis but our study suggests that it is a useful tool in nasal septal surgery, in that it combines both nasal specific and general health questions, which can be analysed individually or together. Improvements in nasal obstruction (75%), facial pain (33%) and catarrh (10%) were noted.     

Evaluation of benefits of nasal septal surgery on nasal symptoms and general health

Objective  The purpose of the study was to analyze the patient’s satisfaction following nasal septal surgery based on their subjective opinion and to study whether the SNOT-22 can be used as a reliable outcome measure for successful septal surgery. Study design  Between Oct 2005–July 2007, sixty consecutive adult patients who underwent nasal septal surgery and met the study criterion were enrolled. The patients were asked to fill in the SNOT-22 questionnaire both prior to and at regular follow up periods after the surgery. Results  The mean total preoperative SNOT score (of all 22 items) was 20.67 and the mean total postoperative SNOT-22 score was 10.48 (t = 8.8135, p < 0.001 highly significant). On further analysis, improvement was seen in subcategories of Nasal Symptoms (t = 8.0825, p < 0.001 highly significant), Non Nasal Symptoms (t = 3.0913, p < 0.0025 significant), General health symptoms (t = 4.8602, p < 0.001 highly significant) and Nasal Obstruction (t = 7.7652, p < 0.001 highly significant). Conclusion  The SNOT-22 score is a useful and reliable tool in nasal septal surgery in that it combines both nasal specific and quality of life related questions, which can be assessed individually and together both pre and post operatively.     

Can snoring relief after nasal septal surgery be predicted?

Patients with nasal obstruction often have associated snoring. This study aims to find out if there are reliable predictors for the success or failure of septal surgery in relieving snoring in patients with symptomatic nasal obstruction secondary to a deviated nasal septum and who have associated snoring. Thirty patients were studied pre-operatively and at 4–12 months (mean 6 months) post-operatively. The intensity of snoring was measured on a visual analogue scale. Nasal patency was measured with a peak nasal inspiratory flow meter. The collapsibility of the soft palate was gauged by the degree of velopharyngeal closure on the Muller manoeuvre. Fifteen patients (50%) achieved snoring relief after septal surgery. The severity of nasal obstruction and intensity of snoring pre-operatively, the magnitude of nasal obstruction relief post-operatively and the degree of collapsibility of the soft palate were found not to influence the outcome of septal surgery on snoring. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after septal surgery is postulated to be important in influencing snoring relief.     

Quality of life assessment septoplasty in patients with nasal obstruction

Naasal obstruction is a common complaint in the population. When caused by a deviated nasal septum, septoplasty is the procedure of choice for treating these patients. NOSE is a tool for assessing the disease-specific quality of life related to nasal obstruction.AimTo assess the impact of septoplasty on patients with nasal obstruction secondary to deviated nasal septum based on the disease-specific quality-of-life questionnaire. Design: Prospective.MethodsPatients undergoing septoplasty with/ without turbinectomy after no clinical improvement with medical treatment were assessed by the NOSE questionnaire before and 3 months after surgery. We evaluated the surgical improvement based on total score, the magnitude of the surgery in the disease-specific quality of life and the correlation between the preoperative score and postoperatively improvement.ResultsFourty-six patients were included in the study. There was a statistically significant improvement in the preoperative NOSE score (md = 75, IQR = 26) and after three months (md = 10, IQR = 20) (p < 0.001.T-Wilcoxon). The standardized response mean was 3.07. We found a strong correlation between the preoperative score in the NOSE questionnaire and improvements in the postoperative period (r = -0.789, p < 0.001, Spearman). No difference was found in improvement scores by gender. (p = 0.668, U-Mann-Whitney).ConclusionSeptoplasty resulted in a statistically significant improvement in the disease-specific QOL questionnaire.     

Nasal valve surgery improves disease-specific quality of life

OBJECTIVES/HYPOTHESIS: Disease-specific quality-of-life (QOL) assessment of patients with nasal valve compromise and symptomatic nasal obstruction has not been studied previously. The objectives of the study were to determine whether surgical treatment of the nasal valve improves disease-specific QOL and to identify clinical or demographic variables predictive of patients' baseline QOL or change in QOL. STUDY DESIGN: Prospective, multi-institutional outcomes study of 20 patients with nasal obstruction and a surgically treatable diagnosis of nasal valve compromise. METHODS: Disease-specific QOL assessment was performed using the Nasal Obstruction Symptom Evaluation (NOSE) scale preoperatively (n = 20) and at 3 (n = 14) and 6 months (n = 20) after surgery. Clinical and demographic data were collected, along with physician-reported assessments of degree of nasal obstruction. RESULTS: Mean NOSE scores significantly improved from baseline to 3 months after surgery (68.9 vs. 20.7 [P < .0001]), from baseline to 6 months after surgery (68.9 vs. 15.8 [P < .0001]), and from 3 to 6 months after surgery (20.7 vs. 15.8 [P = .0077]). Physician assessment of degree of nasal obstruction using a visual analogue scale was significantly correlated with baseline NOSE scores (P = .013) and change in NOSE scores at 6 months (P = .0015). No other clinical or demographic factors were found to be predictive. CONCLUSION: In patients with symptomatic nasal obstruction and nasal valve compromise, surgical repair of the nasal valve improves disease-specific QOL. Physician rating of degree of nasal obstruction was found to be significantly correlated with patient-reported QOL.     

ROE量表在外鼻畸形合并鼻中隔偏曲患者手术前后生存质量评估中的应用

目的 探讨外鼻畸形合并鼻中隔偏曲患者接受鼻内镜辅助下功能性鼻整形术后生存质量的改善情况。 方法 采用鼻整形结局评估量表(ROE)评价,对其进行信度和效度分析,采用汉译的ROE问卷对接受鼻内镜辅助下功能性鼻整形术治疗的外鼻畸形合并鼻中隔偏曲患者手术前后的分值进行比较。 结果 汉译的ROE问卷具有较好的信度和效度,外鼻畸形合并鼻中隔偏曲患者,手术前后ROE分值分别为(38.622±18.136)和(76.603±6.761),差异有统计学意义(t=14.478, P<0.001)。 结论 以ROE作为评价指标,鼻内镜辅助功能性鼻整形术治疗外鼻畸形合并鼻中隔偏曲能使患者的生存质量得以提高。     

Long-term outcomes of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyps

Chronic rhinosinusitis (CRS) significantly affects patient quality of life. Medical and surgical treatments aim to clinically manage the condition.ObjectiveTo assess the long-term quality of life and clinical management of CRS in patients submitted to endoscopic sinus surgery.MethodThis prospective cross-sectional cohort study enrolled 38 patients and looked into the follow-up data of subjects diagnosed with CRS before surgery, three months after surgery, and at least two years after surgery. The Sinonasal Outcome Test 22 (SNOT-22) was used to assess response to treatment and long-term clinical management of the disease.ResultsSignificant improvements in the SNOT-22 scores were seen between the preoperative (61.3) and postoperative assessments with three (16.9) and 24 (32.3) months. No statistically significant differences were seen when patients with polyps were compared to polyp-free subjects. Few patients were controlled in both groups, and 7.89% of the subjects had revision surgery during the study.ConclusionEndoscopic sinus surgery significantly improved the quality of life of patients with chronic rhinosinusitis. Clinical control of the condition was acceptable, with few patients requiring re-operation within two years of the first surgery.     

鼻中隔矫正术治疗变应性鼻炎的临床观察

目的 观察鼻中隔矫正术治疗合并鼻中隔偏曲的变应性鼻炎的疗效。方法 选择1998年1月至2008年10月合并鼻中隔偏曲的变应性鼻炎260例,在局麻下行鼻中隔黏膜下矫正术,同时行单侧下鼻甲部分切除术22例。结果 根据中华医学会耳鼻咽喉科分会变应性鼻炎的疗效评定标准,显效187例（72%）,有效49例（19%）,无效24例（9%）,总有效率91%,术后随访1.5～2年,复发15例（6%）。结论 鼻中隔矫正术可以破坏鼻腔内、外侧壁前部的鼻腔反射和喷嚏反射弧感受器,降低该处的变应性鼻炎发作的扳机点作用,同时降低了鼻腔迷走神经的兴奋性,减轻血管扩张,减少腺体分泌,从而改善症状。该手术安全、有效,易于操作,是治疗变应性鼻炎的有效方法。     

Septoplasty with or without postoperative nasal packing? Prospective study

Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged.ObjectiveTo assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty.MethodPatients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study.ResultsWe had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life.ConclusionSeptoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.     

Sex differences in outcomes of sinus surgery

PURPOSE: Sex has been demonstrated to affect outcome in many diseases. Our current aim is to investigate the relationship between sex and outcomes of endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). METHODS: Forty-four males and 73 females undergoing ESS for CRS with a mean follow-up of 1.4 years were evaluated prospectively. Computed tomography (CT), endoscopy, and quality of life (QOL) assessment was performed. Univariate analyses were performed to evaluate whether sex was predictive of outcome. Multiple logistic regression analysis was performed to evaluate sex association with patient factors predictive of outcome. RESULTS: Although no sex differences in CT and endoscopy were observed (CT, P=.107 and endoscopy, P>.1), females consistently scored worse than males on disease-specific QOL pre- and postoperatively. Importantly, there was no effect of sex on improvement/change scores for the QOL instruments. PREDICTIVE MODELS AND MULTIPLE LOGISTIC REGRESSION ANALYSIS: Sex was not found to be predictive of QOL or endoscopic outcome. Female sex was, however, associated with acetylsalicylic acid (ASA) intolerance and depression, both factors that have been associated with poorer outcome. CONCLUSION: Despite similarities in objective disease measures, females report significantly worse QOL scores pre- and postoperatively. Postoperative improvement did not differ by sex, nor was sex predictive of postoperative outcome. Sex differences in QOL reflect sex differences in ASA intolerance and depression, both more prevalent in females.     

鼻腔填塞法和缝合法及负压法在鼻中隔矫正术后应用的效果观察

目的：评价鼻腔填塞法、缝合法和负压引流技术在鼻中隔偏曲矫正术后应用的疗效。方法：选取接受鼻中隔偏曲矫正术和双下鼻甲骨折外移术患者90例,平均分成3组。填塞组：术后以高分子止血海绵填塞鼻腔;缝合组：术后以可吸收缝线缝合鼻中隔黏膜;负压组：术后鼻腔放置负压引流管。对比观察舒适度评分（采用视觉模拟评分法）、术后鼻腔黏膜水肿程度和鼻中隔血肿、脓肿、粘连、术后治愈率等临床指标。结果：术后12、24h内,疼痛视觉模拟评分法读数、鼻塞视觉模拟评分法读数和病情严重程度比较,缝合组和负压组均优于填塞组（P〈0.05）;术后3d鼻腔黏膜评分比较,缝合组和负压组均明显优于填塞组（P〈0.05）;术后1周治愈率,缝合组和负压组均明显优于填塞组（P〈0.05）,术后7d治愈率和并发症发生例数,缝合组和负压组均明显少于填塞组（P〉0.05）,负压组未出现鼻中隔脓肿、血肿病例。结论：鼻中隔偏曲矫正术后,缝合法和负压法均较填塞法能减轻患者痛苦,缩短术后黏膜恢复时间,不增加术后并发症的发生机率。