Diagnostic and Therapeutic Management of Nasal Airway Obstruction

Mohan, Suresh; Fuller, Jennifer C.; Ford, Stephanie Friree; Lindsay, Robin W.

doi:10.1001/jamafacial.2018.0279

Cited by 33 publications

(35 citation statements)

References 69 publications

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“…Grymer et al utilized acoustic rhinometry to demonstrate decreased nasal volume after rhinoplasty and osteotomies, providing a rationale for concurrent ITR to restore losses in nasal volume . However, volumetric measurements have not been demonstrated to correlate with symptoms of nasal obstruction, although the subsequent development of the NOSE instrument has allowed researchers to correlate patient‐reported symptoms of nasal obstruction with objective measurements. In this study, both SRP and SRPt cohorts improved, demonstrating that ITR is not required in all patients to achieve a significant clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery

et al. 2019

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Objectives: To evaluate the long-term impact of functional septorhinoplasty (SRP) with and without inferior turbinate reduction (ITR) on disease-specific symptom severity and general health-related quality of life (QOL).Study Design: Prospective cohort study at a tertiary referral center. Methods: Patients undergoing functional SRP with and without ITR were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale to assess severity of nasal obstruction and the EuroQol-5 Dimension Questionnaire Visual Analog Scale (EQ-5D VAS) to assess general health-related QOL preoperatively and at 2, 4, 6, 12, 24, and 36 months postoperatively. Patient demographics, surgical technique, symptom severity, and QOL outcomes were analyzed.Results: A total of 567 patients were included, with 391 patients undergoing functional SRP alone (54.0% female; mean age 36.0 years [standard deviation (SD):16.2]) and 176 patients undergoing functional SRP with ITR (50.0% female; mean age 35.6 years [SD:13.6]). There was a significant decrease in NOSE and increase in EQ-5D VAS scores in both groups through at least 24 months postoperatively. Change in NOSE scores was negatively correlated with change in EQ-5D VAS (r = −0.38, P < 0.01). Compared to patients undergoing SRP, patients also undergoing ITR had a statistically but nonclinically significant improvement in NOSE, with similar trends for EQ-5D VAS that were not significant.Conclusion: SRP results in a sustained, long-term improvement in nasal obstruction based on disease-specific and general health-related QOL measures, with incremental improvement in outcomes with addition of ITR. This study provides the foundation for defining health outcomes and the health utility value of surgical interventions that address nasal obstruction.

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Section: Discussionmentioning

confidence: 99%

Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery

et al. 2019

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“…The ventilation function of the upper airway is critical, and the first step of airflow into the upper airway is through the nasal airway. There are many methods for assessing ventilation function, including patient-reported quality of life questionnaires and physical examinations, 76 and some measurement tools such as peak nasal rhinomanometry and acoustic rhinometry. 77 , 78 Measurement of peak nasal inspiratory flow is also an effective method to assess nasal ventilation.…”

Section: Computational Simulation Technology In Clinical Research Of mentioning

confidence: 99%

Computational technology for nasal cartilage-related clinical research and application

Shi

Huang

2020

Int J Oral Sci

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Surgeons need to understand the effects of the nasal cartilage on facial morphology, the function of both soft tissues and hard tissues and nasal function when performing nasal surgery. In nasal cartilage-related surgery, the main goals for clinical research should include clarification of surgical goals, rationalization of surgical methods, precision and personalization of surgical design and preparation and improved convenience of doctor-patient communication. Computational technology has become an effective way to achieve these goals. Advances in three-dimensional (3D) imaging technology will promote nasal cartilage-related applications, including research on computational modelling technology, computational simulation technology, virtual surgery planning and 3D printing technology. These technologies are destined to revolutionize nasal surgery further. In this review, we summarize the advantages, latest findings and application progress of various computational technologies used in clinical nasal cartilage-related work and research. The application prospects of each technique are also discussed.

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“…10 While many physicians use the modified Cottle maneuver to assess subjective improvement in airflow with nasal collapse, it is important to note that this maneuver has poor specificity, and its validation as a presurgical tool is lacking. 11 In the subset of patients who present with a desperate need for improvement of their debilitating nasal obstruction, it is therefore important to use this tool cautiously to prevent overdiagnosing lateral wall insufficiency and subsequent poor surgical outcomes. When performed, very gentle traction of the sidewall to support any inward collapse should be used, with care not to significantly displace the sidewall laterally.…”

Section: Physical Exam Considerationsmentioning

confidence: 99%

Functionally Crippled Nose

Patel

Most

2020

Facial plast Surg

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Nasal obstruction is a common presenting symptom of patients seen by primary care physicians, otolaryngologists, and facial plastic surgeons. A variety of treatment strategies, both surgical and nonsurgical, have been used with success in improving nasal obstruction and quality of life. In a subset of patients, many of whom have either attempted these common treatment strategies or are intolerant of them, nasal obstruction remains a significant symptom. In these patients, there may be an identifiable problem, but it is simply not repairable or there is no identifiable anatomic issue. The management of these patients is discussed in this article, with an emphasis on a sensitive approach that takes into consideration a patient's mental health. While the need for diagnostic testing is generally not necessary for most cases of nasal obstruction, endoscopy and imaging should be considered in these patients. Validated patient-reported outcome measures are particularly helpful in providing an objective measure to a patient's frustrating symptoms. A variety of medications can be either contributory to the patient's symptoms or therapeutic if used appropriately. A variety of surgical interventions can also result in a functionally crippled nose and diagnoses including nasal valve stenosis, septal perforations, and empty nose syndrome are discussed. Importantly, further surgical interventions may not be appropriate if a deformity is minimal, and a surgeon should resist the temptation to proceed with surgery in those situations.

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Diagnostic and Therapeutic Management of Nasal Airway Obstruction

Cited by 33 publications

References 69 publications

Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery

Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery

Computational technology for nasal cartilage-related clinical research and application

Functionally Crippled Nose

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