The Causes of Persistent and Recurrent Nasal Obstruction After Primary Septoplasty

Derin, Serhan; Şahan, Murat; Deveer, Mehmet; Erdoğan, Selvet; Tetiker, Hasan; Köseoğlu, Sabri

doi:10.1097/scs.0000000000002505

Cited by 20 publications

(13 citation statements)

References 14 publications

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“…Additional healthcare resources are also consumed in case of long-term adverse events: severe adhesions, nasal septal perforation, or saddle nose deformity. 12 These complications occur typically within the first year after surgery and may develop after a previously uncomplicated recovery. Based on literature, the risk of developing long-term adverse events was estimated to be 1%.…”

Section: Septoplastymentioning

confidence: 99%

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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Objective The objective of this study was to demonstrate how decision‐analytic modelling can help to determine circumstances under which surgery may become cost‐effective, using septoplasty as an example. Design We developed a decision‐analytic model comparing septoplasty to non‐surgical management for nasal obstruction in adults with a deviated septum. Based on the estimated cost difference between both treatments, we calculated the minimal (a) gain in quality‐adjusted life‐years, or (b) reduction in productivity losses needed for septoplasty to be cost‐effective. Input was derived from literature and publicly available data sources. The time horizon of our model was one year, and the willingness‐to‐pay per quality‐adjusted life‐year was €20 000, in accordance with current guidelines. Results The cost difference between septoplasty and non‐surgical management for nasal obstruction due to a deviated nasal septum was €2227 per patient from a healthcare perspective (including direct healthcare costs) and €3288 per patient from an extended perspective (additionally including travel expenses and productivity losses due to poor health). In comparison with non‐surgical management, septoplasty needed to gain 0.11 to 0.16 QALYs or save 13 sick days for nasal obstruction. The longer septoplasty's effect lasts, the more time it will have to compensate its extra costs. Conclusion This study shows that the known cost difference between treatments can be used as the starting point to determine beneficial effects needed for cost‐effectiveness of surgical interventions. The effect required by septoplasty from a healthcare perspective seems potentially achievable, meaning that it would be useful to perform an RCT assessing the actual benefits of septoplasty.

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Section: Septoplastymentioning

confidence: 99%

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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“…Nasal obstruction due to a septal deviation is a commonly encountered complaint in otolaryngology practice. 1 Patients with a septal deviation resulting in nasal obstruction often undergo a nasal septoplasty, 1-3 the most commonly performed ear, nose, and throat (ENT) operation in adults. 4,5…”

mentioning

confidence: 99%

Determining a Successful Nasal Airway Surgery: Calculation of the Patient‐Centered Minimum Important Difference

Ziai

Bonaparte

2017

Otolaryngol.--head neck surg.

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Objective Determine whether the patient-identified minimum important difference (MID) in Nasal Obstruction Symptom Evaluation (NOSE) score differs from a statistically calculated estimate of MID in patients with septal deviation undergoing nasal airway surgery. Study Design Prospective cohort. Setting Tertiary academic referral center. Subjects Patients with nasal obstruction due to septal deviation. Methods Patients completed the NOSE questionnaire preoperatively and indicated the change from their baseline score that they would consider the minimum improvement required to define the septoplasty with turbinate reduction as successful. A previously published distribution-based approach was used to estimate the MID based on baseline NOSE scores. Scores were reported both as a raw score and as a percentage of patients' baseline scores. One-sample t test was used to compare the statistically estimated MID to the patient-reported MID. Results Seventy-six patients were included. The mean (SD) baseline NOSE score was 12.9 (4.03). The mean (SD) patient-identified MID was 5.3 (2.1), corresponding to a 41.1% change (95% confidence interval, 37.2-41.3) from baseline. The statistically estimated MID was 5.2 points (40.3% reduction from baseline scores). The estimated MID was not significantly different from the patient-identified MID ( P = .4). Conclusion In patients with septal deviation, an improvement of approximately 40% in their nasal obstructive symptoms as assessed by the NOSE questionnaire is required to define a nasal airway surgery as successful. The patient-identified and the statistically calculated MIDs were similar. Furthermore, this MID can be used to guide research, improving the ability to use the NOSE score as a dichotomous scoring measure (treatment success/failure) and estimating sample size.

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“…24 Moreover, concha bullosa might be the cause of nasal obstruction after primary septoplasty, and, if it remains unaddressed, could lead to the persistence of nasal obstruction even after the surgical nasal septum correction. 25,26 Bolger et al . classifies concha pneumatisations as lamellar, bullous or extensive.…”

Section: Discussionmentioning

confidence: 99%

Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomised clinical trial

Andaloro¹,

Mantia

Castro

et al. 2019

J. Laryngol. Otol.

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ObjectiveConcha bullosa may be associated with paranasal sinus infections and nasal obstruction. Middle concha mucosa membranes have olfactory neurofibrils. This study investigated the impact of routinely used concha bullosa surgery techniques – crushing and lateral laminectomy – on nasal and olfactory functions.MethodsForty-three adult patients who had undergone surgery for a symptomatic concha bullosa completed the odour test, nasal obstruction visual analogue scale, 22-item Sino-Nasal Outcome Test, and peak nasal inspiratory flow test, pre-operatively and three months post-operatively. The pre- and post-operative results within and between the two treatment groups were compared.ResultsIntragroup comparison of mean pre- versus post-treatment changes revealed statistically significant findings for the nasal obstruction visual analogue scale, Sino-Nasal Outcome Test, peak nasal inspiratory flow and olfaction tests (all p < 0.05). However, there were no statistically significant changes when comparing the scores between the groups (intergroup comparison).ConclusionLateral laminectomy and crushing in concha bullosa surgery have no negative effects on olfactory function. Concha bullosa surgery provides positive outcomes regarding nasal complaints in symptomatic patients.

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The Causes of Persistent and Recurrent Nasal Obstruction After Primary Septoplasty

Cited by 20 publications

References 14 publications

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Determining a Successful Nasal Airway Surgery: Calculation of the Patient‐Centered Minimum Important Difference

Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomised clinical trial

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