Treatment success after rhinosurgery: an evaluation of subjective and objective parameters

Abstract

Purpose Septal deviation and nose deformities are widely prevalent. As a consequence, patients may complain about difficulties in nasal breathing leading to a perception of diminished disease-specific quality of life. In a prospective randomized trial, we aimed to analyse the outcome of septoplasty (SPL) and septorhinoplasty (SRP) on patient satisfaction. Methods Patients with functional indication for SPL (n = 19) or SRP (n = 54) were included and randomized for additional turbinoplasty. Preoperative clinical symptoms were collected with SNOT-20 GAV (Sinu-nasal outcome test-20—German adapted version) and NOSE© (nasal obstruction symptom evaluation) questionnaires. The final evaluation of treatment success was performed 9 months after surgery with SNOT-20 GAV, NOSE© and a self-established feedback questionnaire. Nasal breathing and obstruction were objectively measured with rhinomanometry and acoustic rhinometry [minimum cross-sectional area 2 (MCA2)]. Results Minimum cross-sectional area 2 was statistically improved compared to the pre-treatment value in SPL (p = 0.0004) and SRP (p = 0.0001). Regarding MCA2 values of matched patient groups, similar findings were detected (SPL: p = 0.0013, SRP: p < 0.0001). Sinu-nasal outcome test-20 GAV and NOSE© scores were significantly reduced after both surgical procedures (NOSE©: SPL: p < 0.0001, SRP: p < 0.0001; SNOT-20 GAV: SPL: p = 0.0068, SRP: p < 0.0001). Evaluation of patient satisfaction in a self-established feedback questionnaire revealed a motivation of 81% of patients to redo the surgery (SPL 13/16, SRP 34/42) and a notably general satisfaction of 86% for SPL and 80% for SRP. Conclusion Rhinosurgery leads to quantitative better nasal breathing and increased disease-specific satisfaction. However, this study implies the importance of the right selection of patients and the correct indication of the surgical technique.

Translation and Validation of the Thai Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale

“…Many objective and subjective measurements have been developed to assess the degree of severity and outcomes of treatment. 9 , 27 Moreover, evaluation using diagnostic algorithms for nasal airway obstruction has also been attempted, although there are difficulties in the application of this algorithm because of the diversity of anatomical causes, discordance between objective examination and subjective perception of patients, and variability among examiners. 5 , 9 As a result, no standardized classification or algorithm has been specifically applied to this symptom.…”

“… 5 , 9 As a result, no standardized classification or algorithm has been specifically applied to this symptom. 27 Subjective reported outcomes have received more attention in the assessment of nasal airway obstruction and therapeutic success. 27 , 28 A systematic review and meta‐analysis conducted in 2017 focused on evaluating the outcomes of nasal airway surgery using NOSE scores.…”

“… 27 Subjective reported outcomes have received more attention in the assessment of nasal airway obstruction and therapeutic success. 27 , 28 A systematic review and meta‐analysis conducted in 2017 focused on evaluating the outcomes of nasal airway surgery using NOSE scores. 29 The results revealed that the improvement of nasal obstruction measured by the NOSE after functional rhinoplasty was sustained for more than 12 months.…”

“…Nasal airway obstruction has multifactorial etiology, and can interfere with the perceived quality of life of patients. Many objective and subjective measurements have been developed to assess the degree of severity and outcomes of treatment 9,27 . Moreover, evaluation using diagnostic algorithms for nasal airway obstruction has also been attempted, although there are difficulties in the application of this algorithm because of the diversity of anatomical causes, discordance between objective examination and subjective perception of patients, and variability among examiners 5,9 .…”

“…Moreover, evaluation using diagnostic algorithms for nasal airway obstruction has also been attempted, although there are difficulties in the application of this algorithm because of the diversity of anatomical causes, discordance between objective examination and subjective perception of patients, and variability among examiners 5,9 . As a result, no standardized classification or algorithm has been specifically applied to this symptom 27 . Subjective reported outcomes have received more attention in the assessment of nasal airway obstruction and therapeutic success 27,28 .…”