Abstract
The goal of this study was to compare the outcome of septoplasty in our patients with previous reports. We found some different outcomes of septoplasty at our center compared with the reports in the literature. One of the major differences between this and previous studies is in the mean age of patients undergoing surgery, 22.44 years in our study vs more than 40 years in most studies. In this study, 86 patients with septal deviation were asked using an outcomes instrument (the Nasal Obstruction Symptom Evaluation scale) before and 3 and 6 months after septoplasty. Seventy-seven patients (89.5%) reported a subjective improvement in their nasal obstruction, which is more than the experience of most authors. There was a significant improvement in mean Nasal Obstruction Symptom Evaluation score at 3 months after septoplasty, and some symptom improvement continued to 6 months. We conclude that younger patients who have nasal obstruction with septal deviation benefit more from septoplasty.
1
Introduction
Nasal obstruction is the most common complaint symptom in nasal and sinus disease . Although symptoms of nasal obstruction can have several etiologies, such as mucosal congestion, turbinate hypertrophy, adenoid hypertrophy, nasal mass, and others, deviation of the nasal septum is a very common cause. Surgical correction of a deviated septum—nasal septoplasty—is the definitive treatment for septal deviation .
Septoplasty is the third most commonly performed surgical procedure by otolaryngologists in the United States and is generally performed to improve quality of life (QOL). The outcomes of this procedure and its impact on QOL have never been clearly established . A number of studies have described both subjective and objective measures of outcome after septoplasty, but most were retrospective .
Multiple outcomes-based studies have demonstrated poor correlation between QOL and physical or anatomic findings, and measurements such as rhinometry do not consistently correlate with patient reports of nasal obstruction and can be inconsistent for predicting septoplasty outcome . In some studies, a validated disease-specific health status instrument was developed and used for patients with nasal obstruction .
We found some different outcomes of septoplasty at our center compared with reports in the literature. These may help to discuss some different outcome in patients.
In this study, we used the Nasal Obstruction Symptom Evaluation (NOSE) scale to study our patients undergoing septoplasty with or without partial turbinectomy and compare the result with other centers.
2
Methods
A prospective multicenter nonrandomized prospective observational study was performed in consecutive patients presenting to Khalili and Dastgheyb Hospitals, Shiraz, Iran, for septoplasty during a 24-month period (June 20, 2006, through June 19, 2008). A total of 103 patients were entered into the study, and 86 patients were available for statistical analysis.
Inclusion criteria were as follows: at least 15 years old, septal deviation consistent with presenting symptom of chronic nasal obstruction, symptoms lasting at least 3 months, and persistent symptoms after a 4-week trial of medical management, including topical nasal steroids, topical or oral decongestants, or an oral antihistamine/decongestant combination.
Patients with histories of sinonasal malignancy, radiation therapy to the head and neck, history or clinical evidence of chronic sinusitis, allergic rhinitis, septal perforation, craniofacial syndrome, acute nasal trauma or fracture in the past 3 months, nasal valve collapse, adenoid hypertrophy, sarcoidosis, Wegener granulomatosis, uncontrolled asthma, pregnancy, and those patients who had undergone other ENT procedures such rhinoplasty and sinus surgery concomitant to septal surgery were excluded from this study.
All patients met eligibility criteria and agreed to participate, gave signed informed consent, and enrolled in the study.
The patients were asked about their symptoms and disease-specific QOL, as measured on the validated NOSE scale ( Fig. 1 ), before surgery in the clinic and subsequently were contacted 3 and 6 months after surgery. They were contacted up to 5 times for follow-up.
| Not a problem | Very mild problem | Moderate problem | Fairly bad problem | Severe problem | |
|---|---|---|---|---|---|
| Nasal obstruction | 0 | 1 | 2 | 3 | 4 |
| Mouth breathing | 0 | 1 | 2 | 3 | 4 |
| Mouth dryness | 0 | 1 | 2 | 3 | 4 |
| Anosmia | 0 | 1 | 2 | 3 | 4 |
| Rhinorrhea | 0 | 1 | 2 | 3 | 4 |
| Epistaxis | 0 | 1 | 2 | 3 | 4 |
| Trouble sleeping | 0 | 1 | 2 | 3 | 4 |
| Snoring | 0 | 1 | 2 | 3 | 4 |
| Being concern about nasal problem | 0 | 1 | 2 | 3 | 4 |
The operation technique was a hemitransfixion incision followed by mucoperichondrium elevation in one or both sides, addressing all areas of deviation, with reshaping and/or removal of the deviated portion. Internal splints and packing were not mandatory. Turbinectomy was defined as a surgical procedure on the inferior nasal turbinate intended to decrease its size, including direct excision, elevation of mucosal flaps with removal of bone only, or cauterization. Turbinectomy was performed according to the physician’s recommendation and the patient’s wishes; no treatment allocation, randomization, or other attempt to modify treatment was made. All physicians were blinded to the patient’s NOSE scores, both before and after treatment, and the physicians did not collect follow-up data from their patients.
Nonparametric analysis (Wilcoxon signed rank test) was used to compare baseline and follow-up NOSE scores. Treatment groups (septoplasty alone vs septoplasty with turbinate procedure) were compared using the nonparametric Wilcoxon rank sum test. A P value less than .05 was considered statistically significant.
2
Methods
A prospective multicenter nonrandomized prospective observational study was performed in consecutive patients presenting to Khalili and Dastgheyb Hospitals, Shiraz, Iran, for septoplasty during a 24-month period (June 20, 2006, through June 19, 2008). A total of 103 patients were entered into the study, and 86 patients were available for statistical analysis.
Inclusion criteria were as follows: at least 15 years old, septal deviation consistent with presenting symptom of chronic nasal obstruction, symptoms lasting at least 3 months, and persistent symptoms after a 4-week trial of medical management, including topical nasal steroids, topical or oral decongestants, or an oral antihistamine/decongestant combination.
Patients with histories of sinonasal malignancy, radiation therapy to the head and neck, history or clinical evidence of chronic sinusitis, allergic rhinitis, septal perforation, craniofacial syndrome, acute nasal trauma or fracture in the past 3 months, nasal valve collapse, adenoid hypertrophy, sarcoidosis, Wegener granulomatosis, uncontrolled asthma, pregnancy, and those patients who had undergone other ENT procedures such rhinoplasty and sinus surgery concomitant to septal surgery were excluded from this study.
All patients met eligibility criteria and agreed to participate, gave signed informed consent, and enrolled in the study.
The patients were asked about their symptoms and disease-specific QOL, as measured on the validated NOSE scale ( Fig. 1 ), before surgery in the clinic and subsequently were contacted 3 and 6 months after surgery. They were contacted up to 5 times for follow-up.
| Not a problem | Very mild problem | Moderate problem | Fairly bad problem | Severe problem | |
|---|---|---|---|---|---|
| Nasal obstruction | 0 | 1 | 2 | 3 | 4 |
| Mouth breathing | 0 | 1 | 2 | 3 | 4 |
| Mouth dryness | 0 | 1 | 2 | 3 | 4 |
| Anosmia | 0 | 1 | 2 | 3 | 4 |
| Rhinorrhea | 0 | 1 | 2 | 3 | 4 |
| Epistaxis | 0 | 1 | 2 | 3 | 4 |
| Trouble sleeping | 0 | 1 | 2 | 3 | 4 |
| Snoring | 0 | 1 | 2 | 3 | 4 |
| Being concern about nasal problem | 0 | 1 | 2 | 3 | 4 |
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