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

Yamasaki, Alisa; Levesque, Patricia A.; Bleier, Benjamin S.; Busaba, Nicolas Y.; Gray, Stacey T.; Holbrook, Eric H.; Sedaghat, Ahmad R.; Lindsay, Robin W.

doi:10.1002/lary.27859

Cited by 25 publications

(31 citation statements)

References 33 publications

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“…We note a greater mean improvement in 12-month postoperative SOS when ITR is performed, although further studies are needed to fully characterize incremental differences in SDB-related outcomes for specific anatomic causes of nasal obstruction and the numerous combinations of rhinoplasty and nasal surgery techniques that can be performed to address obstructive anatomy. 34 There are no widely recognized predictive measures that link the site of nasal obstruction to the degree of snoring improvement that patients may expect after surgery. Our finding that 62.3% of SDB patients had a clinically significant improvement in snoring symptoms at 12 months may be used as a reference to approximate the number of patients who may experience postoperative improvement in snoringrelated QOL.…”

Section: Snoring Outcomes After Septorhinoplasty 29mentioning

confidence: 99%

Improvement in Snoring-Related Quality-of-Life Outcomes After Functional Nasal Surgery

Yamasaki

Levesque

Lindsay

2020

Facial Plastic Surgery & Aesthetic Medicine

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Importance: Sleep-disordered breathing (SDB) represents a spectrum of sleep-related disorders associated with significant medical comorbidities. Nasal airway surgery has been shown to improve SDB but no large-scale studies exist that describe the long-term impact of surgery on patient perception of snoring and nasal obstruction. Objective: To characterize longitudinal snoring symptoms and nasal obstruction after functional nasal surgery for patients with SDB, stratified by history of snoring or obstructive sleep apnea (OSA). Design, Setting, and Participants: In this prospective cohort study, patients undergoing nasal surgery between 2013 and 2017 at a tertiary academic center were surveyed using Snoring Outcome Survey (SOS) and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires through 24 months postoperatively. Patient demographics, history of snoring, diagnosis of OSA, and prior nasal surgeries were analyzed. A total of 625 patients were recruited with 325 females (52.0%) and mean age of 36.3 years (SD 15.6), with 74.9% patients reported snoring (n = 468) and 10.7% patients (n = 67) with OSA. Patients undergoing dual functional and cosmetic septorhinoplasty with or without turbinate surgery were included. Those undergoing concomitant sinus surgery were excluded. Intervention: Functional nasal surgery. Main Outcomes and Measures: SOS and NOSE scores were collected at 2, 4, 6, 12, and 24 months postoperatively. Results: Patients undergoing nasal surgery had statistically and clinically significant improvement in NOSE score at 24 months (mean improvement 29.0 points, p < 0.0001). Patients with snoring history also had significant improvement in SOS score through 24 months (mean improvement 10.7 points, p < 0.0001). Nonsnorers demonstrated no significant change. OSA patients achieved clinically significant improvement in SOS scores through 24 months (mean improvement 31.9; p > 0.05, minimum clinically important difference = 7.6 points). Conclusions and Relevance: Nasal surgery improves long-term nasal obstruction as measured by NOSE score and, for those with comorbid snoring and OSA, can lead to a sustained improvement in snoring-related quality of life (QOL) based on SOS score. Nonsnorers did not have a significant change in snoring symptoms. SOS can be used as a practical and effective instrument to measure snoring-related QOL outcomes after nasal airway surgery. Future studies using objective measures of snoring are needed to quantify the physiologic change in snoring after treatment of nasal obstruction. Level of Evidence: 2c 24% of men aged 30-60 years and 20-56% of women and 28-70% of men over age 65 years in the United States and is associated with medical comorbidities such as hypertension, ischemic heart disease, stroke, and metabolic dysfunction/diabetes. In addition, SDB is associated with

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Section: Snoring Outcomes After Septorhinoplasty 29mentioning

confidence: 99%

Improvement in Snoring-Related Quality-of-Life Outcomes After Functional Nasal Surgery

Yamasaki

Levesque

Lindsay

2020

Facial Plastic Surgery & Aesthetic Medicine

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“…Nevertheless, when a patient has NSD accompanied by chronic nasal obstruction, NSD is considered as a disease. Nasal obstruction is the most common complaint, seriously affecting the patient's quality of life [3,4]. In fact, an NSD is the most common cause of nasal obstruction.…”

Section: Introductionmentioning

confidence: 99%

“…The inferior turbinoplasty is considered to be another important aspect of nasal ventilation surgery except for septoplasty due to the significant role of IT in the physiology of nasal ventilation and the pathology of nasal obstruction [19]. Recently, compensatory hypertrophy of IT second to NSD has turned to be another significant issue [20,21] and it has been proposed that the turbinate reduction surgery should be conducted along with septoplasty [4,[20][21][22]. However, a study by van Egmond et al [8] showed no clinical differences between septoplasty alone and septoplasty with concurrent turbinate surgery.…”

Section: Introductionmentioning

confidence: 99%

“…A great number of the surgical procedures of IT have been reported, including lateralisation, radiofrequency, submucous resection, partial turbinectomy, medial flap inferior turbinoplasty, microdebrider, electrocautery, coblation, etc. [4,8,11,19]. This makes it difficult to evaluate the advantages and disadvantages of each surgical technique.…”

Section: Introductionmentioning

confidence: 99%

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Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

Liu

Qian

Yan

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD). Methods The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed. ResultsThe widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05). ConclusionThe asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.

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“…5 A variety of treatment strategies, both surgical and nonsurgical, have been used with success in improving nasal obstruction and quality of life. [6][7][8] Surgical treatments include septoplasty, turbinate reduction, and functional rhinoplasty with repair of nasal valve stenosis. Nasal steroids and saline irrigation are among the more common medical treatment strategies.…”

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

Cited by 25 publications

References 33 publications

Improvement in Snoring-Related Quality-of-Life Outcomes After Functional Nasal Surgery

Improvement in Snoring-Related Quality-of-Life Outcomes After Functional Nasal Surgery

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

Functionally Crippled Nose

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