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.     

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.     

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.     

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES: The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates. MATERIALS AND METHODS: One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery. RESULTS: In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group. CONCLUSION: MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.     

Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry.

The aim of this study was to evaluate the improvement of nasal flow and the fall of nasal resistance in 50 patients that underwent rhinoseptoplasty in our department and discuss the relative importance of valvular and septal deformities in nasal airway obstruction. Fifty consecutive patients underwent rhinoseptoplasty to improve nasal obstruction caused by severe septal deviation, external or internal valvular incompetence, or any combination of the three. We excluded patients with minor septal curvatures, septal perforations, or turbinate hypertrophy. Preoperative and postoperative rhinomanometry was performed on all 50 patients. In all 50 patients, septal and/or valvular surgery lowered nasal resistance in 90% of cases. Septoplasty alone with medial and basal osteotomies did not improve nasal flow (p < 0.4), whereas the correction of valvular obstruction alone increased nasal airflow in a statistically significant way (p < 0.0001). Moreover, patients with both valvular incompetence and septal deviation represented the group in which the greatest preoperative obstruction and the greatest postoperative improvement occurred. Nasal valvular function should be assessed with rhinomanometry in all preoperative rhinoplasty patients with airway obstruction. In many cases, valvular effects may surpass septal deviation as the primary cause of nasal airflow obstruction.     

Clinical outcomes of nasal septal surgery at high altitude

This study aimed to investigate the clinical outcome of nasal septal surgery at altitude of 2,200 m. The study is a retrospective medical record review. Medical records of 137 patients were investigated in this study; 105 of these patients received septoplasty procedure and 32 received septorhinoplasty procedure at altitude of 2,200 m. Improvement of nasal obstruction was found in 79.6% and no change was seen in 20.4% of the patients. Complications were seen in 30.7%. The most frequent complication was persistent nasal obstruction. Outcomes of nasal septal surgery at high altitude were similar with previous studies done at low altitudes. Although high-altitude environmental factors may result in a number of clinical conditions, high-altitude conditions does not make a significant difference in the outcome of nasal septal surgery.     

改良鼻中隔缝合联合等离子下鼻甲消融在鼻中隔偏曲矫正术中的选择性应用

目的 鼻中隔偏曲矫正术后使用改良鼻中隔缝合技术,等离子消融下鼻甲,术后不填塞鼻腔,比较其与传统方法的疗效.方法 80例行鼻中隔偏曲矫正术患者分为填塞组和缝合组,行鼻中隔矫正术后,填塞组吸切钻切削下鼻甲后行鼻腔填塞,缝合组行改良鼻中隔缝合、等离子消融下鼻甲,无填塞.比较两组患者术后症状、体征评分.结果 填塞组在手术后鼻部...     

A comparative study of septoplasty with or without nasal packing

This study was conducted to compare the outcome of septoplasty with or without Nasal packing. The study subjects were randomly allocated into two groups. There was significant reduction in frequency of post operative pain, headache, discomfort and duration of hospital stay in patients who have undergone septoplasty without nasal packing. However there was no difference in post operative bleeding and septal perforation between two groups. Therefore after Septoplasty without nasal packing is preferred alternative to with nasal packing.     

Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy

Nasal packing may influence the mucociliary clearance of the nose in the postoperative healing phase. In an attempt to overcome some of this problem, a haemostatic septal suturing technique was conceived. In this prospective study, we aimed to investigate the effects of nasal packing and septal suturing technique on mucociliary clearance by rhinoscintigraphy. Forty-eight adult patients who had undergone septoplasty were included in the investigation. Preoperatively, the patients were allocated into three groups: group 1, fingerstall packs filled with gauze and smeared with vaseline were used (11 male, 4 female); group 2, silicon septal splint packs were used (11 male, 4 female); group 3, haemostatic septal sutures were used (14 male, 4 female). Mucociliary clearance was measured by rhinoscintigraphy in all patients before surgery and 6 weeks after surgery. The nasal mucociliary clearance was presented as the velocity (mm/min) of nasal mucociliary transport of the ^99mTc-MAA droplet. The mean velocity of nasal mucociliary clearances before and after surgery for group 1, group 2 and group 3 were 1.85 ± 0.67 versus 2.43 ± 0.78 mm/min, 2.36 ± 0.80 versus 2.92 ± 0.96 mm/min and 2.03 ± 0.58 versus 2.62 ± 0.65 mm/min, respectively. A significant difference in nasal mucociliary clearance was observed after surgery in all groups (p < 0.001). No significant differences were found between the groups regarding mucociliary clearance before and after surgery. Patients with septal deviation have a prolonged mucociliary transit time as compared with postoperative. Nasal packing did not significantly influence the mucociliary clearance in the postoperative healing phase.     

Revision septoplasty: review of sources of persistent nasal obstruction

BACKGROUND: Patients with nasal obstruction from septal deviation commonly undergo septoplasty to improve nasal airflow. Some patients suffer from persistent obstruction after their primary septoplasty and may undergo a revision septoplasty to improve their nasal passageway. Our objective was to identify patients who underwent revision septoplasty and to identify their sources of persistent nasal obstruction. METHODS: Patients who underwent septoplasty at our institution between 1995 and 2005 were reviewed. Data is collected on demographics, comorbidities, age at septoplasty, associated and concomitant procedures, surgical approach, and anatomic site of obstruction. RESULTS: Five hundred forty-seven patients met inclusion criteria including 477 who underwent primary septoplasty and 70 who underwent revision surgery. Nineteen percent of nonrevision patients underwent nasal valve surgery along with their primary septoplasty versus 4% of patients in the revision group. Fifty-one percent of revision patients had nasal valve surgery at revision surgery. Patients who underwent sinus surgery along with primary septoplasty were less likely to undergo revision septoplasty. History of facial trauma, obstructive sleep apnea, site of deviation, and performance of inferior turbinate surgery did not affect the likelihood of revision septoplasty. CONCLUSION: A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.     

Time course in the relief of nasal blockage after septal and turbinate surgery: a prospective study

OBJECTIVE: To evaluate prospectively the time course of the change in efficacy of septal and turbinate surgery in relieving nasal obstruction. DESIGN: Interventional study, before-after trial. SETTING: Referral center, institutional practice, hospitalized care. PATIENTS: Thirty-four consecutive patients undergoing septal and turbinate surgery were recruited. Seven patients were unwilling to complete the follow-up after surgery. No patient withdrawal was because of adverse effects. Twenty-five normal subjects with no nasal obstruction were included as control subjects. INTERVENTION: Functional nasal septal and turbinate surgery was performed to relieve nasal obstruction. MAIN OUTCOME MEASURE: Patient assessment of severity of nasal blockage on a 0-mm (no blockage) to 100-mm (maximum blockage) visual analog scale before surgery and at fixed intervals after surgery. RESULTS: The mean nasal blockage scores significantly decreased from the preoperative values at all intervals of follow-up. For the whole group, the nasal blockage score was on average 52% of the preoperative value at the last follow-up. The probability of having at least a 50% reduction in blockage decreased from 73%, to 60%, to 41%, and then to 27% at 3 months, 6 months, 1 year, and 2(1/2) years, respectively. CONCLUSIONS: Improvement in nasal blockage was found in patients after functional septal and turbinate surgery. However, the probability of substantial relief gradually decreased with time. Patients should be followed up after septal and turbinate surgery for possible recurring symptoms.     

鼻中隔偏曲矫正术后贯穿连续缝合技术的应用与效果分析

目的　评价鼻腔填塞法和鼻中隔贯穿连续缝合技术在鼻中隔偏曲矫正术后应用的疗效及效果分析。方法  选取行鼻中隔偏曲矫正术患者158例,随机分成2组。填塞组：术后以高分子止血海绵填塞鼻腔;缝合组：术后以可吸收缝线立即行贯穿连续缝合鼻中隔黏膜。术后对患者主观不适感以视觉模拟评分法（visual analogue scale,VAS）进行评分,观察术后鼻腔黏膜水肿程度和鼻中隔血肿、粘连、术后治愈率等临床指标。结果　术后48 h内两组患者在鼻部疼痛、头部疼痛、溢泪、耳鸣/耳闷、睡眠困难、吞咽困难 6个方面的VAS评分均值比较,差异均有统计学意义。两组在术后出血量、鼻中隔血肿、鼻腔粘连、穿孔、感染等方面比较差异无统计学意义。结论　鼻中隔偏曲矫正术后缝合法较填塞法能减轻患者痛苦,不增加术后并发症的发生机率。     

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.     

Effect of total nasal obstruction on nocturnal oxygen saturation

BACKGROUND: Nasal obstruction is considered a risk factor for sleep-disordered breathing (SDB), although the relationship has not been established clearly. This study explores the repercussion of total nasal packing on arterial oxygen saturation during the nocturnal resting hours and its implication in SDB. METHODS: Forty patients were subjected to total nasal packing after nasal surgery or epistaxis. In all cases the oxygen desaturation index (ODI) was monitored with and without nasal packs, and the results were compared. RESULTS: Thirty-seven patients (92.5%) showed poorer oxygen saturation after nasal occlusion. Of these, 19 patients (47.5%) reached pathological desaturation (ODI > or = 12). Desaturation was greater among obese subjects. CONCLUSION: Total nasal packing causes significant nocturnal oxygen desaturation. This must be taken into account in the postoperative nasal packing of patients with respiratory failure, obesity, or SDB.     

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.     

Alternatives to packing in septorhinoplasty

Nasal packing is considered routine by most physicians and patients at the completion of nasal and septal surgery. Yet the rationale for this maneuver is not clearly defined by reported investigation or logical analysis. We discuss 75 consecutive nasal surgical procedures completed without packing. There were two postoperative episodes of bleeding, both from pyriform aperture incisions for lateral osteotomy and both managed in the recovery room with an absorbable gelatin sponge. Technical refinements such as scrupulous preoperative history taking, through-and-through suturing of the entire septal flaps, small-caliber osteotomy, meticulous closure of all intranasal incisions, and proper application of a conforming dressing are essential for hemostasis. We offer specific procedural guidance to minimize the risk of postoperative nasal bleeding.     

Effect of nasal packing on eustachian tube function

Sixty-three patients undergoing surgery to the nasal septum followed by bilateral packing had pre- and post-operative tympanometry in order to determine the effect on eustachian tube function. Fifty-five of the 126 ears tested (46 per cent) developed a reduction in middle ear pressure of at least 50 daPa; 76 per cent became normal within 24 hours of removing the nasal packs. All ears were asymptomatic and no patient had evidence of middle ear effusion. Nasal packing following septal surgery is a frequent cause of short-lasting eustachian tube dysfunction but rarely severe enough to cause symptoms or middle ear effusion. Tubal dysfunction is most likely due to a combination of surgical oedema and a direct effect of the nasal packing.     

The effect of duration of nasal obstruction on mean platelet volume in patients with marked nasal septal deviation

Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. This study aimed to investigate the effect of age on mean platelet volume in patients with marked nasal septal deviation. We made a retrospective study of patients with marked nasal septal deviation between January 2012 and May 2014. The patients were divided into four groups according to duration of nasal obstruction (less than 10, 10–20, 20–30 and more than 30 years). The groups were compared with each other in terms of mean platelet volume, platelet distribution width, platelet count in preoperative hemogram. This study was performed on 356 male and 139 female patients. Mean age was 33.9 ± 12.3 years. It was determined that the platelet count, mean platelet volume did not constitute statistically significant difference between groups (p > 0.05). Nevertheless, it was determined that as the duration of nasal obstruction elongated the mean platelet volume value increased and platelet count values decreased. Mean values of platelet distribution width constituted statistically significant difference between all groups (p = 0.026). Patients with marked nasal septum deviation should be subjected to surgery as soon as possible because of the increase in mean platelet volume and platelet distribution width values which are related to increase in the risk of cardiopulmonary complications of nasal obstruction.     

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

OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULT: 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. CONCLUSION: 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.