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Long-term patient-related outcome measures of septoplasty: a systematic review

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Abstract

Purpose

Septoplasty is a common rhinological procedure intended to relieve symptoms of chronic nasal obstruction. However, there remains a question as to whether patients obtain symptom improvement and are satisfied with surgical outcomes in the months and years after septoplasty. This review aims to evaluate the long-term efficacy of functional septoplasty for nasal septal deviation.

Methods

A systematic review of the literature was conducted from November 2014 to March 2016 using the Cochrane, EMBASE, and PubMed databases. Prospective trials concerning functional septoplasty, which assessed subjective outcomes and included long-term follow-up data (≥ 9 month post-septoplasty) were included.

Results

2189 articles were screened with seven meeting the criteria for inclusion. Patient satisfaction was assessed in six studies, with rates of satisfaction provided in three of these, ranging from 69 to 100%. Two studies assessed the degree of patient satisfaction, with one study indicating that 88% of patients were moderately satisfied or better at 1 year post-op, and the other reporting that 50% of patients were satisfied. In assessing symptom relief, several methods were used, including validated questionnaires, with varying degrees of improvement in nasal obstruction reported.

Conclusions

Septoplasty appears to be a far from perfect treatment for nasal obstruction due to septal deviation. However, given the heterogeneity of data and lack of randomized controlled trials (RCTs), future RCTs and use of validated questionnaires would enable generation of superior levels of evidence. We suggest future prospective trials evaluating prognostic factors in septoplasty, to better inform patients and facilitate the development of guidelines for surgical intervention.

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References

  1. Vainio-Mattila J (1974) Correlations of nasal symptoms and signs in random sampling study. Acta Otolaryngol Suppl 318:1–48

    Article  Google Scholar 

  2. Bhattacharyya N (2010) Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Laryngoscope 120(3):635–638

    Article  PubMed  Google Scholar 

  3. Ahn JC et al (2016) Prevalence and risk factors of chronic rhinosinusitus, allergic rhinitis, and nasal septal deviation: results of the Korean national health and nutrition survey 2008–2012. JAMA Otolaryngol Head Neck Surg 142(2):162–167

    Article  PubMed  Google Scholar 

  4. Salihoglu M et al (2014) Examination versus subjective nasal obstruction in the evaluation of the nasal septal deviation. Rhinology 52(2):122–126

    CAS  PubMed  Google Scholar 

  5. Stefanini R et al (2012) Systematic evaluation of the upper airway in the adult population of Sao Paulo, Brazil. Otolaryngol Head Neck Surg 146(5):757–763

    Article  PubMed  Google Scholar 

  6. Stewart MG et al (2004) Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130(2):157–163

    Article  PubMed  Google Scholar 

  7. Rhee JS, McMullin BT (2008) Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. Arch Facial Plast Surg 10(3):194–207

    Article  PubMed  Google Scholar 

  8. Swedish Association of Local Authorities and Regions, S.N.B.o.H.a.W. (2013) Quality and Efficiency in Swedish Health Care—Regional Comparisons 2012, S.N.B.o.H.a. Welfare, Editor. Ordförrådet AB, Stockholm

  9. Andrews PJ et al (2015) The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer? Clin Otolaryngol 40(6):698–703

    Article  CAS  PubMed  Google Scholar 

  10. Moore, M. and R. Eccles (2011) Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clin Otolaryngol 36(2):106–113

    Article  CAS  PubMed  Google Scholar 

  11. Sipila J, Suonpaa J (1997) A prospective study using rhinomanometry and patient clinical satisfaction to determine if objective measurements of nasal airway resistance can improve the quality of septoplasty. Eur Arch Otorhinolaryngol 254(8):387–390

    Article  CAS  PubMed  Google Scholar 

  12. Tompos T et al (2010) Sensation of nasal patency compared to rhinomanometric results after septoplasty. Eur Arch Oto Rhino Laryngo 267(12):1887–1891

    Article  Google Scholar 

  13. Kjaergaard T, Cvancarova M, Steinsvag SK (2009) Nasal congestion index: a measure for nasal obstruction. Laryngoscope 119(8):1628–1632

    Article  PubMed  Google Scholar 

  14. Larsen K, Oxhoj H (1988) Spirometric forced volume measurements in the assessment of nasal patency after septoplasty. A prospective clinical study. Rhinology 26(3):203–208

    CAS  PubMed  Google Scholar 

  15. Kimbell JS et al (2012) Computed nasal resistance compared with patient-reported symptoms in surgically treated nasal airway passages: a preliminary report. Am J Rhinol Allergy 26(3):e94–e98

    Article  PubMed  PubMed Central  Google Scholar 

  16. Murrell GL (2014) Correlation between subjective and objective results in nasal surgery. Aesthet Surg J 34(2):249–257

    Article  PubMed  Google Scholar 

  17. Constantinides MS, Adamson PA, Cole P (1996) The long-term effects of open cosmetic septorhinoplasty on nasal air flow. Arch Otolaryngol Head Neck Surg 122(1):41–45

    Article  CAS  PubMed  Google Scholar 

  18. Kahveci OK et al (2012) The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation. Auris Nasus Larynx 39(3):275–279

    Article  PubMed  Google Scholar 

  19. Daudia A et al (2006) A prospective objective study of the cosmetic sequelae of nasal septal surgery. Acta Otolaryngol 126(11):1201–1205

    Article  CAS  PubMed  Google Scholar 

  20. Hsu HC et al (2017) 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 42(1):53–59

    Article  CAS  PubMed  Google Scholar 

  21. Andre RF et al (2009) Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 34(6):518–525

    Article  CAS  PubMed  Google Scholar 

  22. Arunachalam PS et al (2001) Nasal septal surgery: evaluation of symptomatic and general health outcomes. Clin Otolaryngol Allied Sci 26(5):367–370

    Article  CAS  PubMed  Google Scholar 

  23. Jessen M, Ivarsson A, Malm L (1989) Nasal airway resistance and symptoms after functional septoplasty: comparison of findings at 9 months and 9 years. Clin Otolaryngol Allied Sci 14(3):231–234

    Article  CAS  PubMed  Google Scholar 

  24. Bohlin L, Dahlqvist A (1994) Nasal airway resistance and complications following functional septoplasty: a ten-year follow-up study. Rhinology 32(4):195–197

    CAS  PubMed  Google Scholar 

  25. De Sousa Fontes A, Sandrea Jimenez M, Chacaltana Ayerve RR (2013) Endoscopic septoplasty in primary cases using electromechanical instruments: surgical technique, efficacy and results. Acta Otorrinolaringol Esp 64(5):317–322

    Article  PubMed  Google Scholar 

  26. Haroon Y, Saleh HA, Abou-Issa AH (2013) Nasal soft tissue obstruction improvement after septoplasty without turbinectomy. Eur Arch Otorhinolaryngol 270(10):2649–2655

    Article  PubMed  Google Scholar 

  27. Illum P (1997) Septoplasty and compensatory inferior turbinate hypertrophy: long-term results after randomized turbinoplasty. Eur Arch Oto Rhino Laryngol 254(Suppl 1):S89–S92

    Google Scholar 

  28. Konstantinidis I et al (2005) Long term results following nasal septal surgery. Focus on patients’ satisfaction. Auris Nasus Larynx 32(4):369–374

    Article  PubMed  Google Scholar 

  29. Pirila T, Tikanto J (2001) Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment. Am J Rhinol 15(2):127–133

    Article  CAS  PubMed  Google Scholar 

  30. Meltzer EO et al (2006) Rhinosinusitis: developing guidance for clinical trials. Otolaryngol Head Neck Surg 135(5 Suppl):S31–S80

    Article  PubMed  Google Scholar 

  31. Anderson K et al (2016) The impact of septoplasty on health-related quality of life in paediatric patients. Clin Otolaryngol 41(2):144–148

    Article  CAS  PubMed  Google Scholar 

  32. Hong SD et al (2015) Predictive factors of subjective outcomes after septoplasty with and without turbinoplasty: can individual perceptual differences of the air passage be a main factor? Int Forum Allergy Rhinol 5(7):616–621

    Article  PubMed  Google Scholar 

  33. Lipan MJ, Most SP (2013) Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg 15(5):358–361

    Article  PubMed  Google Scholar 

  34. Holmstrom M (2010) The use of objective measures in selecting patients for septal surgery. Rhinology 48(4):387–393

    PubMed  Google Scholar 

  35. Sedaghat AR et al (2013) Clinical assessment is an accurate predictor of which patients will need septoplasty. Laryngoscope 123(1):48–52

    Article  PubMed  Google Scholar 

  36. Han JK et al (2015) Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngol Head Neck Surg 153(5):708–720

    Article  PubMed  Google Scholar 

  37. Dinis PB, Haider H (2002) Septoplasty: long-term evaluation of results. Am J Otolaryngol 23(2):85–90

    Article  PubMed  Google Scholar 

  38. Gandomi B, Bayat A, Kazemei T (2010) Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study. Am J Otolaryngol 31(3):189–192

    Article  PubMed  Google Scholar 

  39. Siegel NS et al (2000) Outcomes of septoplasty. Otolaryngol Head Neck Surg 122(2):228–232

    Article  CAS  PubMed  Google Scholar 

  40. Zeng R et al (2014) Univariate and multivariate analyses for postoperative bleeding after nasal endoscopic surgery. Acta Otolaryngol 134(5):520–524

    Article  CAS  PubMed  Google Scholar 

  41. Karatzanis AD et al (2009) Septoplasty outcome in patients with and without allergic rhinitis. Rhinology 47(4):444–449

    PubMed  Google Scholar 

  42. Mondina M et al (2012) Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires. Eur Arch Otorhinolaryngol 269(10):2189–2195

    Article  PubMed  Google Scholar 

  43. Bothra R, Mathur NN (2009) Comparative evaluation of conventional versus endoscopic septoplasty for limited septal deviation and spur. J Laryngol Otol 123(7):737–741

    Article  CAS  PubMed  Google Scholar 

  44. van Egmond MM et al (2015) Effectiveness of septoplasty versus non-surgical management for nasal obstruction due to a deviated nasal septum in adults: study protocol for a randomized controlled trial. Trials 16:500

    Article  PubMed  PubMed Central  Google Scholar 

  45. Prus-Ostaszewska M et al (2017) The correlation of the results of the survey SNOT-20 of objective studies of nasal obstruction and the geometry of the nasal cavities. Otolaryngol Pol 71(2):1–7

    Article  PubMed  Google Scholar 

  46. Hopkins C et al (2009) Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 34(5):447–454

    Article  CAS  PubMed  Google Scholar 

  47. Piccirillo JF, Merritt Jr MG, Richards ML (2002) Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 126(1):41–47

    Article  PubMed  Google Scholar 

  48. Robinson K, Gatehouse S, Browning GG (1996) Measuring patient benefit from otorhinolaryngological surgery and therapy. Ann Otol Rhinol Laryngol 105(6):415–422

    Article  CAS  PubMed  Google Scholar 

  49. Bugten V et al (2016) Quality of life and symptoms before and after nasal septoplasty compared with healthy individuals. BMC Ear Nose Throat Disord 16:13.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sundh C, Sunnergren O (2015) Long-term symptom relief after septoplasty. Eur Arch Otorhinolaryngol 272(10):2871–2875

    Article  PubMed  Google Scholar 

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Acknowledgements

Mr. Lars Eriksson for his expertise in generating search criteria. Dr. Emma Badenoch-Jones for her guidance and support in the systematic review of journal articles.

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Correspondence to Chi Lap Nicholas Tsang.

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This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors do not have any financial conflicts of interest. One author is a practicing Otolaryngologist who performs septoplasty as a non-financial conflict of interest.

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Tsang, C.L.N., Nguyen, T., Sivesind, T. et al. Long-term patient-related outcome measures of septoplasty: a systematic review. Eur Arch Otorhinolaryngol 275, 1039–1048 (2018). https://doi.org/10.1007/s00405-018-4874-y

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