flow (NPIF) all measure subtly different constructs of nasal function. All have limitations but NPIF is simple and quick to integrate into clinical practice. The minimum clinically important difference (MCID) for an outcome measure is an estimate of the smallest change that is experienced by a patient or group as being significant. Studies, particularly with large samples, may generate results that while statistically significant, have limited clinical effect. Defining MCID allows an assessment of the clinical impact of an intervention. This study defines the MCID for NPIF. Methods: Prospective study of patients from a tertiary clinic undergoing open septorhinoplasty. Nasal obstruction scores and NPIF were recorded before and after surgery. Global function and nasal obstruction scores were used to assess subjective change. Statistical based and patient anchored techniques were used to define MCID. Results: 51 patients with a mean age 36 ± 13 yrs (75% female) were recruited. All had open rhinoplasty, septal reconstruction, spreader grafts and turbinate reduction. Baseline NPIF was 101 ± 35 L/min. The statistically derived MCID (half standard deviation) was 18 L/min, the patient anchored approaches were 20 L/min and 20-25 L/min. Discussion: Although NPIF is effort dependant with the potential for poor test-retest reliability, it is simple, quick and a reliable technique can be quickly learnt. An MCID of 20L/min is recommended when NPIF is used as an outcome tool. Understanding the MCID is critical for assessing the impact of nasal surgery.

Successful treatment of sinonasal disease may require postoperative delivery of topical therapies. Draf III frontal sinusotomy achieves superior topical access, and access to the frontal sinus with Draf IIa appears limited, despite large volumes and positioning.

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The external approach for septoplasty is an operation that produces significant improvements in subjective and objective nasal health measures. Although requiring greater training and operative time, it is an appropriate approach for the severely deviated nasal septum.

IMPORTANCE External nasal valve dysfunction (EVD) is a common cause of nasal obstruction.OBJECTIVE To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD. DESIGN, SETTING, AND PARTICIPANTSIn this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty. MAIN OUTCOMES AND MEASURES Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. RESULTS Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02). CONCLUSIONS AND RELEVANCE Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD. LEVEL OF EVIDENCE 2.