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

Andrews, Peter; Choudhury, Natasha; Takhar, Arunjit; Poirrier, Anne‐Lise; Jacques, Thomas; Randhawa, Premjit S

doi:10.1111/coa.12455

Cited by 52 publications

(75 citation statements)

References 26 publications

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“…Unfortunately, a widely used and accepted direct measure of nasal airflow does not currently exist. Prior attempts to directly quantify nasal airflow, for example, using nasal rhinomanometry and acoustic rhinometry, have failed to gain widespread use due to expense, test burden, and a lack of correlation with patient‐reported outcomes measures . Because the goal of nasal surgery is to increase quality of life, improvement in patient‐reported outcome measures (PROMs) is essential; however, understanding how the surgeries we perform alter nasal function is also critical to continued surgical advancement.…”

Section: Introductionmentioning

confidence: 99%

Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty

et al. 2018

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Objective To evaluate the utility of peak nasal inspiratory flow (PNIF) as a measure of nasal airflow and functional septorhinoplasty (FSRP) outcomes. Methods Patients with nasal obstruction were administered Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and PNIF testing between January 2015 and 2018. Surgical patients repeated these tests at 2, 4, 6, 12, and 24 months postoperatively. Patient demographics and operative techniques were recorded. Results A total of 610 patients were evaluated for nasal obstruction with mean (standard deviation [SD]) NOSE score of 61.5 (23.2) and PNIF of 74.1 (35.4) liters per minute (L/min); correlation −0.16 (P < 0.001). Predictors of lower PNIF were female gender (β = −13.3, 95% confidence interval [CI] 7.7 to 18.2, P < .001) and higher NOSE scores (β = −0.43, 95% CI 0.19 to 0.68, P < 0.001). A total of 281 patients underwent FSRP with statistically and clinically significant improvements in both mean NOSE and PNIF scores that were stable out to 2 years. NOSE scores changed −41.0 (25.5) points, and PNIF improved 20.7 (35.5) L/min at last follow‐up. Grafting material did not affect outcomes, whereas spreader grafts improved PNIF values (β = 25.46, 95% CI 5.5 to 45.4, P = 0.013). Clinically significant changes between NOSE and PNIF were concordant, although the correlation was weak (r = −0.26, P = 0.02). Conclusion Peak nasal inspiratory flow is a rapid, cheap, and easily performed test that detects nasal obstruction and clinically significant improvements in airflow following FSRP. Although PNIF does not correlate well enough with the patient experience of nasal obstruction to be used as a diagnostic tool, it does provide unique and complementary information useful for evaluating, understanding, and improving the effects of surgical techniques. Level of Evidence 2C Laryngoscope, 129:594–601, 2019

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Section: Introductionmentioning

confidence: 99%

Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty

et al. 2018

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“…We decided against this as it proved challenging to measure with regards to explaining to the patient the force of deep inspiration required and also we were very conscious to keep this simple and easy to use in our busy clinical setting. In addition, controversy exists regarding the dynamic evaluation of nasal obstruction [3–5]. While acoustic rhinometry may provide a static measure of the cross-sectional area across the INV, the placement of the probe itself splints the nasal airway and therefore invalidates measurement of the INV through this modality.…”

Section: Discussionmentioning

confidence: 99%

“…There have been numerous attempts to validate clinical, instrumental and qualitative questionnaires to quantify degrees of nasal obstruction with varying successes [2–5]. …”

Section: Introductionmentioning

confidence: 99%

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The internal nasal valve: a validated grading system and operative guide

Patel

Virk

Randhawa

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeNasal obstruction is a highly subjective and commonly reported symptom. The internal nasal valve (INV) is the rate limiting step to nasal airflow. A static INV grading score was devised with regard to visibility of the middle turbinate.MethodsA prospective study of all patients who underwent primary external functional septorhinoplasty in 2017 for nasal obstruction. All patients’ INV score was assessed pre- and postoperatively in a blinded and independent fashion by surgeons of varying seniority.ResultsTwenty-eight patients were studied, with mean age 30.9 years and follow-up 18.8 weeks. Inter-rater and test–retest reliability of INV grading were excellent, with Cronbach’s alpha 0.936 and 0.920, respectively. There was also statistically significant improvement in both subjective and objective postoperative outcome measures including nasal inspiratory peak flows.ConclusionsWe demonstrate a novel, easy to interpret, clinically valuable grading system of the static internal nasal valve that is reliable and reproducible.

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“…This decreases the applicability of the result to resting nasal patency, and may explain its limited correlation with subjective symptom scores. 11 The technique is also unable to delineate the level of obstruction.…”

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confidence: 99%

A UK survey of current ENT practice in the assessment of nasal patency

Andrews

Joseph

et al. 2017

J. Laryngol. Otol.

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ObjectivesNasal obstruction is a common presentation in ENT practice, and yet decisions on its management are challenging, with high rates of patient and clinician dissatisfaction following surgery. The aim of the study was to investigate the practice of UK ENT clinicians in the subjective and objective evaluation of nasal patency. DesignVoluntary, written questionnaire. SettingBritish Academic Conference in Otolaryngology 2015, Liverpool, UK. Participants UK-based ENT professionals. Results UK based rhinologists were surveyed at the 2015 British Academic Conference inOtorhinolaryngology (BACO) from a cohort of 250 delegates attending two symposia on rhinology with a response rate of 78/250. Clinical history and examination were found to be almost universally used in the evaluation of nasal blockage. The most commonly used clinical test was the nasal misting pattern demonstration on a metal spatula (73%), followed by the peak nasal inspiratory flow rate (19%). The most commonly used subjective measure was the sinonasal outcome test (SNOT-22/23), with a 29% uptake.63% of the responders reported that non-availability of suitable equipment was the main reason for not using objective measures, followed by time consumption, and the lack of correlation with subjective symptom scores. ConclusionsOur study demonstrated that British clinicians rely largely on clinical skills to evaluate nasal blockage. There is a desire for a simple, practical, non-invasive device which a) objectively measures airflow during physiological resting nasal breathing, b) correlates with subjective symptom scores, and c) is capable of simultaneous measurement of each nostril.

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

Cited by 52 publications

References 26 publications

Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty

Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty

The internal nasal valve: a validated grading system and operative guide

A UK survey of current ENT practice in the assessment of nasal patency

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