Comparison of Subjective and Objective Success of Septoplasty in Patients with Nasal Septum Deviation: A Before and After Study

Objective: Aim of the study is to evaluate the subjective outcomes and objective outcomes postoperatively and investigate correlations between these measurements. Material and Methods: This prospective before and after surgical study was conducted with patients admitted with symptomatic nasal septum deviation (NSD) and who underwent Cottle’s septoplasty. Morphometric diameters of the nasal cavity were measured using a multi-detector computed tomography. Preoperative and postoperative one-month Nasal Obstruction Symptom Evaluation Scale (NOSE) score, acoustic rhinometry (AR), and anterior active rhinomanometry (AAR) measurements were used to evaluate the success of surgery. The correlations between these measurements were also evaluated. Results: The study population consisted of 30 patients, including 19 males and 11 females, with a median age of 27.5 years. There was a statistically significant difference between pre and postoperative NOSE scores, with a mean difference of 53.17 points (p<0.001). There were statistically significant differences between pre and postoperative AR parameters of both the deviated side (DS) and non-deviated side (NDS) of the nose both before and after decongestion. There were statistically significant improvements in all postoperative airflow and airway resistance parameters of the DS of the nose before decongestion when compared to preoperative measurements. There were moderate to large positive correlations between morphometric diameters and differences in NOSE score. Further, there were several statistically significant correlations between differences in AR and AAR measurements and differences in NOSE score. Conclusion: Our findings showed that the objective measurements are strongly correlated with the NOSE score.

Keywords:

Pyriform aperture, choana nasal septum deviation, septoplasty,

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1. Konstantinidis I, Triaridis S, Triaridis A, Karagiannidis K, Kontzoglou G. Long term results following nasal septal surgery. Focus on patients’ satisfaction. Auris, Nasus, Larynx 2005;32(4):369-74. google scholar
2. Tsang CLN, Nguyen T, Sivesind T, Cervin A. Long-term patient-related outcome measures of septoplasty: a systematic review. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2018;275(5):1039-48. google scholar
3. Sedaghat AR, Busaba NY, Cunningham MJ, Kieff DA. Clinical assessment is an accurate predictor of which patients will need septoplasty. Laryngoscope 2013;123(1):48-52. google scholar
4. Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches.Otolaryngol Clin North Am 2018;51(5):909-17. google scholar
5. Hsu HC, Tan CD, Chang CW, Chu CW, Chiu YC, Pan CJ, et al. Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study.Clin Otolaryngol 2017;42(1):53-9. google scholar
6. Moore M, Eccles R. Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clin Otolaryngol 2011;36(2):106-13. google scholar
7. Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am 2009;42(2):241-52. google scholar
8. Kim JS, Heo SJ. Questionable Effect of Crosshatching Incision in Septoplasty. Clin Exp Otorhinolaryngol 2020;13(1):47-51. google scholar
9. Most SP, Rudy SF. Septoplasty: Basic and Advanced Techniques. Facial Plast Surg Clin North Am 2017;25(2):161-9. google scholar
10. Mondina M, Marro M, Maurice S, Stoll D, de Gabory L. Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires. Eur Arch Otorhinolaryngol 2012;269(10):2189-95. google scholar
11. Sahin C. Evaluation of Patient Satisfaction After Nasal Septoplasty Operation Using Peak Nasal Inspiratory Flow and Nasal Obstruction Symptom Score Questionnaire. J Craniofac Surg 2016;27(5):1289-91. google scholar
12. Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic Review and Meta-analysis of Studies Evaluating Functional Rhinoplasty Outcomes with the NOSE Score. Otolaryngol Head Neck Surg 2017;156(5):809-15. google scholar
13. Mladina R. The role of maxillary morphology in the development of pathological septal deformities. Rhinology. 1987;25(3):199-205. google scholar
14. Aksu F GMN, Kahveci O, Cırpan S, Karabekir S. Diameters of piriform aperture and choana: An anatomic study. Dokuz Eylül Univ Sch Med J. 2013;27(1):1-6. google scholar
15. Hilberg O, Pedersen OF. Acoustic rhinometry: recommendations for technical specifications and standard operating procedures. Rhinol Suppl 2000;16:3-17. google scholar
16. Clement PA, Gordts F. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005;43(3):169-79. google scholar
17. Cantone E, Ricciardiello F, Oliva F, De Corso E, Iengo M. Septoplasty: is it possible to identify potential “predictors” of surgical success? Acta Otorhinolaryngol Ital 2018;38(6):528-35. google scholar
18. Andre RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenite GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009;34(6):518-25. google scholar
19. Apaydın E, İkincioğulları A, Çolak M, Atan D, Ensari S, Dere HH. The Voice Performance After Septoplasty With Surgical Efficacy Demonstrated Through Acoustic Rhinometry and Rhinomanometry. J Voice 2020;34(4):649.e15-.e20. google scholar
20. Eren SB, Tugrul S, Dogan R, Ozucer B, Ozturan O. Objective and subjective evaluation of operation success in patients with nasal septal deviation based on septum type. Am J Rhinol Allergy 2014;28(4):e158-62. google scholar
21. Lodder WL, Leong SC. What are the clinically important outcome measures in the surgical management of nasal obstruction? Clin Otolaryngol 2018;43(2):567-71. google scholar
22. Ziai H, Bonaparte JP. Determining a Successful Nasal Airway Surgery: Calculation of the Patient-Centered Minimum Important Difference. Otolaryngol Head Neck Surg 2017;157(2):325-30. google scholar
23. Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004;130(3):283-90. google scholar
24. Vogt K, Jalowayski AA, Althaus W, Cao C, Han D, Hasse W, et al. 4-Phase-Rhinomanometry (4PR)--basics and practice 2010. Rhinol Suppl 2010;21:1-50. google scholar
25. Lara-Sânchez H, Âlvarez Nuno C, Gil-Carcedo Sanudo E, Mayo Iscar A, Vallejo Valdezate L. Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. Acta Otorrinolaringol Esp 2017;68(3):145-50. google scholar
26. Mengi E, Cukurova I, Yalçın Y, Yiğitbaşı OG, Karaman Y. [Evaluation of operation success in patients with nasal septal deviation with quality of life scale and objective methods]. Tr-ENT 2011;21(4):184-91. google scholar
27. Gamerra M, Cantone E, Sorrentino G, De Luca R, Russo MB, De Corso E, et al. Mathematical model for preoperative identification of obstructed nasal subsites. Acta Otorhinolaryngol Ital. 2017;37(5):410-5. google scholar
28. Jones AS, Willatt DJ, Durham LM. Nasal airflow: resistance and sensation. J Laryngol Otol 1989;103(10):909-11. google scholar
29. Pirila T, Tikanto J. Acoustic rhinometry and rhinomanometry in the preoperative screening of septal surgery patients. Am J Rhinol Allergy 2009;23(6):605-9. google scholar
30. Haavisto LE, Sipila JI. Acoustic rhinometry, rhinomanometry and visual analogue scale before and after septal surgery: a prospective 10-year follow-up. Clin Otolaryngol 2013;38(1):23-9. google scholar
31. De Corso E, Bastanza G, Di Donfrancesco V, Guidi ML, Morelli Sbarra G, Passali GC, et al. Radiofrequency volumetric inferior turbinate reduction: long-term clinical results. Acta Otorhinolaryngol Ital 2016;36(3):199-205. google scholar