Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work?

Abstract

Septorhinoplasty aims to improve not only the esthetic appearance but also breathing function of the nose. Although the esthetic improvement can be judged by the patient and the surgeon easily, evaluation of nasal breathing is more complicated. Besides the subjective symptom scores given by the patient, some objective methods have been developed. One of the most widely used of these objective methods is acoustic rhinometry, which gives valuable information about the cross-sectional areas and volumes of the nasal airway as a function of distance from the nostril. Since the introduction of acoustic rhinometry, many papers were reported regarding its efficiency with some conflicting conclusions. Septorhinoplasty has the potential to narrow the nasal airway, especially if it includes lateral osteotomies and hump reduction. We aimed to evaluate the role of rhinoplasty on nasal obstruction with the help of subjective symptom scores and acoustic rhinometry. The study consisted of 26 patients who underwent septorhinoplasty. Before and after surgery, the symptom scores and findings of acoustic rhinometry were collected both before and after decongestion of the nasal mucosa. Symptom scores decreased on both sides, which were statistically significant (p< 0.05), however, the changes in cross-sectional areas of the nasal airway were not statistically significant (p > 0.05). The correlation between the symptom scores and acoustic rhinometry findings was not significant for all levels. The effect of septorhinoplasty on nasal airway and some important maneuvers to protect against nasal obstruction are discussed.

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

“…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.…”

“…Other studies suggest longer efficacy for medial flap turbinoplasty beginning between 12 and 24 months, with lower reported revision rates (12%) compared to electrocautery (54%) or powered submucosal resection (i.e., microdebrider; 40%) during 60‐month follow‐up (n = 100) . These studies are limited by the lack of standardized outcomes, with measures based on rhinomanometry and acoustic rhinometry of unclear clinical significance given the lack of established correlation with PROMs . Ongoing analyses in large studies will be required to continue probing longitudinal, clinically significant differences between ITR techniques.…”

The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?

“…Ozkul et al 18 showed an improvement in NIPF after septoplasty in 50 patients and concluded that this was a good method of evaluating nasal patency as his results were comparable to a control group of 219 patients. Edizer et al, 19 on the other hand, did not find a correlation between the improvement in nasal volume and symptomology following septorhinoplasty. Marais et al and Eren et al showed increases in NIPF values after septoplasty.…”

Acoustic rhinometry and video endoscopic scoring to evaluate postoperative outcomes in endonasal spreader graft surgery with septoplasty and turbinoplasty for nasal valve collapse

“…Edizer et al evaluated 26 patients undergoing septorhinoplasty for objective improvement in nasal airway using acoustic rhinometry and subjective improvements using a 10-point visual analog scale [ 8 ]. Although the patients all underwent septorhinoplasty, not all had preoperative complaints of nasal obstruction.…”