Systematic Review and Meta‐analysis of Studies Evaluating Functional Rhinoplasty Outcomes with the NOSE Score

Abstract

Objective To provide aggregate data regarding the ability of functional rhinoplasty to improve nasal obstruction as measured by the Nasal Obstruction Symptom Evaluation (NOSE) score. Data Sources PubMed, EMBASE, Cochrane databases. Review Methods A search was performed with the terms "nasal obstruction" and "rhinoplasty." Studies were included if they evaluated the effect of functional rhinoplasty on nasal obstruction with the NOSE score. Case reports, narratives, and articles that did not use the NOSE score were excluded. Functional rhinoplasty was defined as surgery on the nasal valve. This search resulted in 665 articles. After dual-investigator independent screening, 16 articles remained. Study results were pooled with a random effects model of meta-analysis. Change in NOSE score after surgery was assessed via the mean difference between baseline and postoperative results and the standardized mean difference. Heterogeneity was assessed and reported through the I statistic. Results Patients in the included studies had moderate to severe nasal obstructive symptoms at baseline. The NOSE scores were substantially improved at 3-6, 6-12, and ≥12 months, with absolute reductions of 50 points (95% CI, 45-54), 43 points (95% CI, 36-51), and 49 points (95% CI, 39-58), respectively. All of these analyses showed high heterogeneity. Conclusions Nasal obstruction as measured by the NOSE survey is reduced by 43 to 50 points (out of 100 points) for 12 months after rhinoplasty. Our confidence in these results is limited by heterogeneity among studies, large variability in outcomes beyond 12 months, and the inherent potential for bias in observational studies.

Twelve‐month outcomes of a bioabsorbable implant for in‐office treatment of dynamic nasal valve collapse

“…The improvement in nasal obstruction symptoms measured by the mean NOSE score reduction in this study is similar to that reported in surgical studies in the OR setting. A meta‐analysis by Floyd et al pooled 16 studies and reported a mean 49‐point (95% confidence interval [CI], 39–58) NOSE score reduction at 12+ months after functional rhinoplasty . Similarly, a recent meta‐analysis published by Kandathil et al also reported a 49.0‐point (95% CI 35.8–62.1) NOSE score reduction at 6+ months after functional rhinoplasty .…”

Assessment of bioabsorbable implant treatment for nasal valve collapse compared to a sham group: a randomized control trial

“…The improvement in NAO symptoms, measured by the mean NOSE score reduction in the treatment arm, is similar to what has been reported in surgical studies in the operating room setting. A recent meta‐analysis of functional rhinoplasty studies reported a 50‐point (95% confidence interval [CI], 45 to 54) mean NOSE score reduction 3 to 6 months after treatment . Similarly, another recent meta‐analysis that focused on lateral nasal wall repair surgical studies reported a 45.0‐point (95% CI, 42.2 to 47.8) mean NOSE score reduction ≤3 months after treatment .…”

Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty

“…Previously published studies have described patient populations with a relatively high prevalence of differential loss to follow‐up or with heterogeneous trends in NOSE scores. A recent systematic review and meta‐analysis of 16 studies using NOSE score outcomes after functional rhinoplasty by Floyd et al showed significant and sustained improvement of NOSE scores at 3 to 6 month (n = 6 studies), 6 to 12 months (n = 7 studies), and greater than 12 months (n = 4 studies). Their analysis required pooling of data samples with different lengths of follow‐up and different intervals of reporting, prohibiting drawing definitive conclusions regarding the trend of NOSE scores longitudinally.…”