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Rossi Meyer MK, Most SP. Quantifying the Subjective Experience of Nasal Obstruction: A Review. Facial Plast Surg 2024; 40:336-340. [PMID: 37625460 DOI: 10.1055/a-2160-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
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Affiliation(s)
- Monica K Rossi Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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2
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Hamdan AT, Cherobin GB, Voegels RL, Rhee JS, Garcia GJM. Effects of Mucosal Decongestion on Nasal Aerodynamics: A Pilot Study. Otolaryngol Head Neck Surg 2024; 170:1696-1704. [PMID: 38461407 DOI: 10.1002/ohn.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Mucosal decongestion with nasal sprays is a common treatment for nasal airway obstruction. However, the impact of mucosal decongestion on nasal aerodynamics and the physiological mechanism of nasal airflow sensation are incompletely understood. The objective of this study is to compare nasal airflow patterns in nasal airway obstruction (NAO) patients with and without mucosal decongestion and nondecongested healthy subjects. STUDY DESIGN Cross-sectional study of a convenience sample. SETTING Academic tertiary medical center. METHODS Forty-five subjects were studied (15 nondecongested healthy subjects, 15 nondecongested NAO patients, and 15 decongested NAO patients). Three-dimensional models of the nasal anatomy were created from computed tomography scans. Steady-state simulations of airflow and heat transfer were conducted at 15 L/min inhalation rate using computational fluid dynamics. RESULTS In the narrow side of the nose, unilateral nasal resistance was similar in decongested NAO patients and nondecongested healthy subjects, but substantially higher in nondecongested NAO patients. The vertical airflow distribution within the nasal cavity (inferior vs middle vs superior) was also similar in decongested NAO patients and nondecongested healthy subjects, but nondecongested NAO patients had substantially less middle airflow. Mucosal cooling, quantified by the surface area where heat flux exceeds 50 W/m2, was significantly higher in decongested NAO patients than in nondecongested NAO patients. CONCLUSION This pilot study suggests that mucosal decongestion improves objective measures of nasal airflow, which is consistent with improved subjective sensation of nasal patency after decongestion.
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Affiliation(s)
- Ahmad T Hamdan
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Giancarlo B Cherobin
- Department of Ophthalmology and Otorhinolaryngology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Richard L Voegels
- Department of Ophthalmology and Otorhinolaryngology, Universidade de São Paulo, São Paulo, Brazil
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Guilherme J M Garcia
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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3
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Harvey RJ, Roland LT, Schlosser RJ, Pfaar O. Chief Complaint: Nasal Congestion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00414-8. [PMID: 38677589 DOI: 10.1016/j.jaip.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.
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Affiliation(s)
- Richard John Harvey
- Rhinology & Skull Base, University of New South Wales and Macquarie University, Sydney, Australia.
| | - Lauren T Roland
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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Zasadzińska-Stempniak K, Zajączkiewicz H, Kukwa A. Correlation between Subjective Nasal Patency and Nasal Capacity in Young Adults: A Pilot Study with a Prototype Device-A Nasoorospirometer. J Clin Med 2024; 13:2506. [PMID: 38731035 PMCID: PMC11084303 DOI: 10.3390/jcm13092506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32-0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies.
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Affiliation(s)
- Katarzyna Zasadzińska-Stempniak
- Department of Otorhinolaryngology, Head and Neck Diseases, School of Medicine, University of Warmia and Mazury in Olsztyn, al. Warszawska 30, 10-082 Olsztyn, Poland
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Yan X, Menzel S, Zhao K, Kim K, Hummel T. Intranasal trigeminal sensitivity to mechanical stimuli is associated with the perception of nasal patency. Eur Arch Otorhinolaryngol 2023; 280:5391-5399. [PMID: 37561188 DOI: 10.1007/s00405-023-08126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The aim of this prospective study was to examine the characteristics of a clinical test for the assessment of nasal trigeminal sensitivity to mechanical stimuli and its association with the perception of nasal patency. METHODS Thirty-two normosmic healthy subjects participated (17 women and 15 men; age = 26 ± 3 years). Precisely defined air puffs were used with a flow rate of 2L/min for mechanical stimulation. They were presented to the nasal vestibule, nasal septum, and inferior turbinate with various stimulus durations. Thresholds were measured by single-staircase stimuli with changes in stimulus duration in steps of 10 ms. Trigeminal suprathreshold intensity was rated by subjects for stimulus durations of 200, 300, 400, and 500 ms. Test-retest reliability was examined by intraclass correlations (ICCs) and Bland-Altman plot with limits of agreement. Pearson's correlations were calculated between self-rated nasal patency and nasal trigeminal sensitivity. RESULTS As indicated by trigeminal threshold and suprathreshold intensities, the nasal vestibule is the most sensitive area among the three locations, followed by the nasal septum and the inferior turbinate (p < 0.001). Coefficients of correlations between test and retest were 0.76 for thresholds, and 0.56 suprathreshold intensities (p < 0.001). The Bland-Altman analysis showed a good agreement between test-retest values. In addition, significant positive associations between trigeminal suprathreshold intensities and self-rated nasal obstruction were found at the inferior turbinate (r = 0.4, p < 0.05). CONCLUSION Reliable assessment of nasal trigeminal sensitivity for air puffs appears to be possible. Nasal trigeminal suprathreshold sensitivity to mechanical stimuli is associated with the perception of nasal patency at the inferior turbinate. This opens a window into the assessment of the perception of nasal airflow in various clinical purposes, especially for patients with sinonasal diseases. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Xiaoguang Yan
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Susanne Menzel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kai Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kanghyun Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Warinner C, Loyo M, Gu J, Wamkpah NS, Chi JJ, Lindsay RW. Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation. Facial Plast Surg 2023; 39:517-526. [PMID: 37290455 DOI: 10.1055/s-0043-1769806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.
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Affiliation(s)
- Chloe Warinner
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Jeffrey Gu
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Nneoma S Wamkpah
- Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Robin W Lindsay
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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Most SP. Invited Discussion on: Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales. Aesthetic Plast Surg 2023; 47:735-737. [PMID: 36651982 DOI: 10.1007/s00266-023-03253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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Alan MA, Kahraman ME, Yüksel F, Yücel A. Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales. Aesthetic Plast Surg 2022; 47:728-734. [PMID: 36302983 DOI: 10.1007/s00266-022-03151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/14/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dorsal preservation techniques have been preferred and gained popularity in recent years. The current study compares the effects of dorsal preservation and dorsal reduction rhinoplasty on nasal patency and aesthetic outcomes by using Patient-Reported Outcome Measures (PROMs) and rhinomanometry. To our knowledge, this is the first study to compare dorsal preservation and dorsal reduction techniques with rhinomanometry. METHODS This is a prospective study of 34 patients who underwent rhinoplasty between January 2021-June 2022. The patients were randomly selected preoperatively and divided into two groups as structural rhinoplasty (SR) and preservation rhinoplasty (PR). Nasal Obstruction and Symptom Evaluation (NOSE), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scales and rhinomanometric evaluation were performed preoperatively, at 3rd month and 12th month postoperatively. RESULTS Nineteen patients (10 female, 9 male) were in SR group, 15 patients (7 female, 8 male) were in PR group. There was not significant difference in terms of age and gender between groups. In both groups, NOSE, SCHNOS-O and SCHNOS-C results were found to be significantly lower at postoperative 3rd and 12th month compared to preoperatively (p < 0.001 for the entire SR group, p = 0.001 for the entire PR group). There was no significant difference between groups in terms of PROMs. Mean total nasal volume (TNV) at 12th month were statistically higher than preoperative value in PR group (p = 0.031). Also there was no significant difference in SR group and between groups in terms of rhinomanometry results. CONCLUSION Dorsal preservation with pushdown technique provides good functional and aesthetic results comparable with structural rhinoplasty. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . A well-designed prospective clinical trial.
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de Oliveira GMM, Correia Júnior MADV, Costa EC, Lira GVDAG, Rizzo JÂ, Hunter S, Gaua N, Sarinho ESC. Accuracy of peak nasal flow to determine nasal obstruction in patients with allergic rhinitis. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:155-161. [PMID: 35612507 PMCID: PMC9131999 DOI: 10.14639/0392-100x-n1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
Objective Methods Results Conclusions
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10
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Malik J, Spector BM, Wu Z, Markley J, Zhao S, Otto BA, Farag AA, Zhao K. Evidence of Nasal Cooling and Sensory Impairments Driving Patient Symptoms With Septal Deviation. Laryngoscope 2022; 132:509-517. [PMID: 34125439 PMCID: PMC8669045 DOI: 10.1002/lary.29673] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS About 260,000 septoplasties are performed annually in the US to address nasal septal deviation (NSD). Yet, we do not consistently understand what aspects of NSD result in symptoms. STUDY DESIGN Blinded cohort study. METHODS Two fellowship-trained surgeons blindly reviewed computerized tomography (CTs) of 10 confirmed NSD patients mixed with 36 healthy controls. All patients were correctly identified, however, 24/36 controls were falsely identified by both surgeons as patients (33.3% specificity), which were grouped as asymptomatic NSD (aNSD), while the remaining controls as non-NSD (healthy). Acoustic rhinometry, rhinomanometry, individual CT-based computational fluid dynamics and nasal sensory testing were applied to address the puzzling questions of why these aNSD had no symptoms and, more fundamentally, what caused symptoms in sNSD patients. RESULTS aNSD reported no nasal symptoms - Nasal Obstruction Symptom Evaluation score (sNSD: 60.50 ± 13.00; aNSD: 5.20 ± 5.41; non-NSD: 6.66 ± 7.17, P < .05); 22-item Sino-Nasal Outcome Test score (sNSD: 32.60 ± 14.13; aNSD: 10.04 ± 10.10; non-NSD: 9.08 ± 12.42, P < .001). No significant differences in measured nasal resistance, minimum cross-sectional area (MCA), degree of septal deviation, and nasal airflow distributions were found between sNSD and aNSD groups. Only three variables differentiate sNSD versus aNSD: anterior averaged heat flux on deviated side, inferior turbinate peak heat flux on non-deviated side, and nasal cool sensitivity measured by menthol lateralization threshold, with no significant differences among these variables found between the two healthy groups (aNSD vs. non-NSD). These variables by themselves or combined can differentiate sNSD from controls with higher specificity than the physicians (ROC area under the curve = 0.84 with 70% sensitivity and 91.6% specificity). CONCLUSIONS This study sheds light on the potential mechanisms of NSD symptomatology: distorted nasal cooling due to NSD exacerbated by poorer nasal mucosal sensitivity. It further supports our previous hypothesis that nasal obstruction complaints do not result directly from obstruction, rather from the capacity of our nose to subjectively sense airflow cooling. LEVEL OF EVIDENCE 3 Laryngoscope, 132:509-517, 2022.
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Affiliation(s)
- Jennifer Malik
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Barak M. Spector
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Zhenxing Wu
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Jennifer Markley
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, OH
| | - Bradley A. Otto
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Alexander A. Farag
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kai Zhao
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
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Verkest V, Pingnet L, Fransen E, Declau F. Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients. Aesthetic Plast Surg 2022; 46:1323-1331. [PMID: 35022839 DOI: 10.1007/s00266-021-02662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. STUDY DESIGN This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. METHODOLOGY Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. RESULTS There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. CONCLUSION During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Valérie Verkest
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium.
| | - Laura Pingnet
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium
| | - Erik Fransen
- StatUa, Center of Statistics, University of Antwerp, Antwerp, Belgium
| | - Frank Declau
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Deng Y, Wang C, Shen S, Yang X, Lou H, Zhang L. Effects of Acute Alcohol Intake on Nasal Patency. Am J Rhinol Allergy 2021; 36:330-338. [PMID: 34839720 DOI: 10.1177/19458924211062322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute alcohol intake may influence nasal patency; however, there is lack of objective evidence. OBJECTIVE The aim of this study was to evaluate the effects of acute alcohol intake on nasal patency employing both subjective and objective measures. METHODS A total of 31 participants were classified into 2 groups of non-heavy drinkers (n = 17) and heavy drinkers (n = 14). Both groups consumed wine in 1 h and were assessed for subjective nasal symptoms and objective nasal patency, using rhinomanometry and acoustic rhinometry, at baseline and at 0.5, 2, and 6 h post-alcohol consumption. RESULTS Alcohol consumption significantly increased nasal obstruction from baseline values in both heavy and non-heavy drinking groups. Total nasal volume (TNV) and the minimal cross-sectional area (MCA) were significantly decreased and nasal airway resistance (NAR) significantly increased from baseline values by 2 h post-alcohol consumption for both heavy and non-heavy drinking groups (P < .05). Significant differences were found in TNV, MCA, and NAR between baseline and post-drinking in allergic rhinitis subjects; with no significant differences in MCA and NAR in subjects without allergic rhinitis. Pulse rate (PR) and temperature (T) were elevated, and blood pressure (BP) was decreased after alcohol consumption (P < .05). Blood alcohol concentration (BAC) was not significantly correlated with nasal patency with regard to any subjective or objective measurement. CONCLUSION Acute alcohol consumption may impair nasal patency, independent of the amount consumed. Individuals with allergic rhinitis may be more prone to nasal obstruction after alcohol consumption than those without allergic rhinitis.
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Affiliation(s)
- Yuzhoujia Deng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Shen Shen
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Xiaozhe Yang
- Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Nasal Diseases and Beijing Laboratory of allergic diseases, Beijing Institute of Otorhinolaryngology, Beijing, P.R. China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, P.R. China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
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Abstract
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.
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14
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Jiang S, Chan J, Stupak HD. The Use of Infrared Thermal Imaging to Determine Functional Nasal Adequacy: A Pilot Study. OTO Open 2021; 5:2473974X211045958. [PMID: 34616996 PMCID: PMC8489757 DOI: 10.1177/2473974x211045958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objective The goal of this study was to establish a numeric threshold to separate functional from substantially obstructed noses using comparisons of thermal imaging and subjective scores. Study Design An inexpensive smartphone application and hardware attachment that uses infrared thermal imaging was tested to differentiate between substantial nasal blockage from an adequately functioning nose. Setting Sequential adult participants who presented to a public hospital otolaryngology clinic between June and August 2018 were asked to complete the Nasal Obstruction Symptom Evaluation (NOSE) tool. Methods A thermal video imaging device was used to record the difference in temperature (ΔT) between inspired (I) and expired (E) air at each nostril. The nostril ΔT between I and E air of patients with severe obstruction by the subjective measure (NOSE score) was compared with that of patients with minimal symptoms. Results A total of 26 participants were enrolled in the study. During normal respiration, Total ΔT for the nonobstructed group had a mean of 9.0, whereas the Total ΔT for the obstructed group had a mean of 7.69, a 17% difference that was statistically significant at P = .045. For the worst-performing nostril tested, ΔT for the nonobstructed group had a mean/median of 4°C, while the obstructed group had a mean of 3.23°C (median 3; 23.8% difference, P = .023). Conclusion Measures of thermal imaging, particularly at the threshold between the median scores of the worst-performing nostril, may be a useful clinical test to differentiate between a substantially obstructed nose from an adequately functioning nose, although more data are required.
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Affiliation(s)
- Sydney Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center/Children's Hospital of Montefiore, Bronx, New York, USA
| | - Jason Chan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Howard D Stupak
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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15
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Computational Fluid Dynamics Modeling of Nasal Obstruction and Associations with Patient-Reported Outcomes. Plast Reconstr Surg 2021; 148:592e-600e. [PMID: 34550944 DOI: 10.1097/prs.0000000000008328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasal obstruction is a common problem, with significant impact on quality of life. Accurate diagnosis may be challenging because of the complex and dynamic nature of the involved anatomy. Computational fluid dynamics modeling has the ability to identify specific anatomical defects, allowing for a targeted surgical approach. The goal of the current study is to better understand nasal obstruction as it pertains to disease-specific quality of life by way of a novel computational fluid dynamics model of nasal airflow. METHODS Fifty-three patients with nasal obstruction underwent computational fluid dynamics modeling based on computed tomographic imaging. Nasal resistance was compared to demographic data and baseline subjective nasal patency based on Nasal Obstructive Symptom Evaluation scores. RESULTS Mean Nasal Obstructive Symptom Evaluation score among all patients was 72.6. Nasal Obstructive Symptom Evaluation score demonstrated a significant association with nasal resistance in patients with static obstruction (p = 0.03). There was a positive correlation between Nasal Obstructive Symptom Evaluation score and nasal resistance in patients with static bilateral nasal obstruction (R2 = 0.32) and poor correlation in patients with dynamic bilateral obstruction caused by nasal valve collapse (R2 = 0.02). Patients with moderate and severe bilateral symptoms had significantly higher nasal resistance compared to those with unilateral symptoms (p = 0.048). CONCLUSIONS Nasal obstruction is a multifactorial condition in most patients. This study shows correlation between simulated nasal resistance and Nasal Obstructive Symptom Evaluation score in a select group of patients. There is currently no standardized diagnostic algorithm or gold standard objective measure of nasal airflow; however, computational fluid dynamics may better inform treatment planning and surgical techniques on an individual basis. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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16
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Kaura A, Pendolino AL, Navaratnam A, Andrews PJ, Leung TS. The Nasal Obstruction Balance Index: A Novel Approach to Improving Correlation Between Unilateral Nasal Airway Measurements and Evaluating Nasal Airway Asymmetry. Laryngoscope 2021; 131:E2833-E2840. [PMID: 33949695 DOI: 10.1002/lary.29597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Demonstrate that the Nasal Obstruction Balance Index (NOBI) model fulfils the unmet need of improving unilateral correlation between subjective and objective nasal obstruction outcome measures and identifying the more obstructed side. Improve correlation between unilateral objective nasal airway measurements (nasal inspiratory peak flow [NIPF] and acoustic rhinometry [AR]) and subjective Visual Analogue Scale for nasal obstruction (VAS-NO) scores. Improve assessment of nasal airway asymmetry by evaluating unilateral measurements both before and after the application of nasal decongestant; which the patient could better understand. NOBI represents a ratio calculated by taking the difference between left and right nasal airway measurements and divided by the maximum unilateral measurement. It is based on Poiseuille's law and aims to reduce the confounding variables which challenge nasal airway measurement. STUDY DESIGN Prospective cohort study. METHODS Forty-three controls and 34 patients with nasal obstruction underwent both unilateral and bilateral NIPF, AR and VAS-NO measurements; these were repeated after the application of nasal decongestant. The NOBI values for unilateral NIPF, AR, and VAS-NO were calculated both before and after decongestant. RESULTS The correlation between unilateral NIPF and AR measurements was enhanced considerably (r = 0.57, P < .01) when NOBI was applied. The NOBI metric significantly increased the correlation between unilateral NIPF, AR, and VAS-NO scores. Postdecongestant NOBI for NIPF and AR measurements correctly identified the more obstructed side in 82.4% and 94.1% of the deviated nasal septum (DNS) cases, respectively. CONCLUSION The NOBI model provides a better correlation between unilateral subjective and objective measurements and identifies the more obstructed side. LEVEL OF EVIDENCE Prospective cohort study (level III) Laryngoscope, 2021.
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Affiliation(s)
- Anika Kaura
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Alfonso Luca Pendolino
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Annakan Navaratnam
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Peter J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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17
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Sinha P, Chi JJ. Commentary on "The Rhinoplasty Healthcare Monitor: Using Validated Questionnaires and a Web-Based Outcome Dashboard to Evaluate Personal Surgical Performance" by van Zijl et al. Facial Plast Surg Aesthet Med 2021; 24:213-214. [PMID: 33861624 DOI: 10.1089/fpsam.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Parul Sinha
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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18
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Mehta S, Wang D, Kuo CL, Mu J, Vich ML, Allareddy V, Tadinada A, Yadav S. Long-term effects of mini-screw-assisted rapid palatal expansion on airway. Angle Orthod 2021; 91:195-205. [PMID: 33315060 DOI: 10.2319/062520-586.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate the long-term effects on airway in patients with mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis. MATERIALS AND METHODS A total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated. RESULTS Both MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume. CONCLUSIONS There was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.
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Xavier R, Menger DJ, de Carvalho HC, Spratley J. An Overview of Computational Fluid Dynamics Preoperative Analysis of the Nasal Airway. Facial Plast Surg 2021; 37:306-316. [PMID: 33556971 DOI: 10.1055/s-0041-1722956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Evaluation of the nasal airway is crucial for every patient with symptoms of nasal obstruction as well as for every patient with other nasal symptoms. This assessment of the nasal airway comprises clinical examination together with imaging studies, with the correlation between findings of this evaluation and symptoms reported by the patient being based on the experience of the surgeon. Measuring nasal airway resistance or nasal airflow can provide additional data regarding the nasal airway, but the benefit of these objective measurements is limited due to their lack of correlation with patient-reported evaluation of nasal breathing. Computational fluid dynamics (CFD) has emerged as a valuable tool to assess the nasal airway, as it provides objective measurements that correlate with patient-reported evaluation of nasal breathing. CFD is able to evaluate nasal airflow and measure variables such as heat transfer or nasal wall shear stress, which seem to reflect the activity of the nasal trigeminal sensitive endings that provide sensation of nasal breathing. Furthermore, CFD has the unique capacity of making airway analysis of virtual surgery, predicting airflow changes after trial virtual modifications of the nasal airway. Thereby, CFD can assist the surgeon in deciding surgery and selecting the surgical techniques that better address the features of each specific nose. CFD has thus become a trend in nasal airflow assessment, providing reliable results that have been validated for analyzing airflow in the human nasal cavity. All these features make CFD analysis a mainstay in the armamentarium of the nasal surgeon. CFD analysis may become the gold standard for preoperative assessment of the nasal airway.
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Affiliation(s)
- Rui Xavier
- Department of Otorhinolaryngology, Hospital Luz Arrabida, Porto, Portugal
| | - Dirk-Jan Menger
- Department of Otorhinolaringology, University Medical Center, Utrecht, The Netherlands
| | - Henrique Cyrne de Carvalho
- Department of Medicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Spratley
- Department of Otorhinolaringology, Faculdade de Medicina da Universidade do Porto, Centro Hospitalar e Universitário S. João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal
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20
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Skirko JR, James KT, Shusterman DJ, Weaver EM. Association of Allergic Rhinitis With Change in Nasal Congestion in New Continuous Positive Airway Pressure Users. JAMA Otolaryngol Head Neck Surg 2021; 146:523-529. [PMID: 32271366 DOI: 10.1001/jamaoto.2020.0261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal congestion occurring after continuous positive airway pressure (CPAP) treatment initiation impairs CPAP adherence. Allergic rhinitis is associated with worsening nasal congestion in patients who are exposed to nonallergic triggers. Use of CPAP presents potential nonallergic triggers (eg, humidity, temperature, pressure, and airflow). Objective To compare nasal congestion among CPAP users with allergic rhinitis, nonallergic rhinitis, and no rhinitis. We hypothesize that CPAP patients with baseline allergic rhinitis are more likely to experience a worsening of nasal congestion (or less improvement in nasal congestion) compared with patients with no baseline rhinitis. Design, Setting, and Participants This prospective cohort study included consecutive patients newly diagnosed with obstructive sleep apnea in a tertiary sleep center who were using CPAP therapy 3 months after diagnosis. Baseline rhinitis status was assigned as allergic rhinitis, nonallergic rhinitis, or no rhinitis, based on questionnaire responses and past allergy testing. Data were collected from 2004 to 2008 and analyzed from July 2019 to February 2020. Main Outcomes and Measures At baseline before CPAP exposure and again 3 months later, subjective nasal congestion was measured with the Nasal Obstruction Symptom Evaluation (NOSE) scale and a visual analog scale (VAS), each scored from 0 to 100 (100 = worst congestion). Changes in nasal congestion were tested over 3 months for the whole cohort, within each rhinitis subgroup (paired t test), and between rhinitis subgroups (multivariate linear regression). Results The study cohort comprised 102 participants, of whom 61 (60%) were male and the mean (SD) age was 50 (13). The study included 23 (22.5%) participants with allergic rhinitis, 67 (65.7%) with nonallergic rhinitis, and 12 (11.8%) with no rhinitis. Nasal congestion improved from baseline to 3 months in the whole cohort (mean [SD] NOSE score, 38 [26] to 27 [23], mean [SD] change, -10 [23]; 95% CI, -15 to -6; mean [SD] VAS score, 41 [27] to 32 [28]; mean [SD] change, -10 [26]; 95% CI, [-15 to -4]) and in each rhinitis subgroup. Adjusted improvement in nasal congestion at 3 months was significantly less in the allergic rhinitis subgroup compared with the no rhinitis subgroup (positive difference means less improvement) compared with baseline: NOSE score 14 (95% CI, 1 to 28) and VAS score 15 (95% CI, 0 to 30). Conclusions and Relevance Initiation of CPAP was associated with improved subjective nasal congestion, but less improvement in patients with baseline allergic rhinitis. Baseline allergic rhinitis may predict which patients are more vulnerable to potential congestive effects of CPAP.
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Affiliation(s)
- Jonathan R Skirko
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Utah, Salt Lake City
| | - Kathryn T James
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle
| | - Dennis J Shusterman
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.,Surgery Service, Seattle VA Medical Center, Seattle, Washington
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21
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Naguib MB, Ahmed MR, Madian YT, Elnahriry TM, Eldeeb WE. Functional and aesthetic outcomes of spreader graft and auto-spreader flap after nasal hump removal. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2020. [DOI: 10.1186/s43163-020-00058-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Following the reduction of the nasal hump to a desired level, spreader grafts are usually positioned to prevent the complication of nasal valve collapse. Auto-spreader flap is a new technique that gained more popularity recently and can be used as an alternative to spreader graft. This RCCT compared between both techniques aesthetically and functionally as well as the operative time.
Results
Forty patients, 17 males (42.5%) and 23 females (57.5%), were included. The mean duration of operation in auto-spreader flap was 11.8 ± 3.4 min, while it was 19.2 ± 3.2 min in spreader graft. The difference between the two procedures was statistically significant (P < 0.05). Functional assessment of nasal obstruction was done for all patients in both groups preoperative that was (75.6 ± 19.9) which showed marked improvement when re-evaluated 3 moths postoperatively (18.9 ± 14.7), and after 6 months NOSE scale was (29.1 ± 20.2). The overall aesthetic satisfaction was 62.5% (25 of 40) irrespective of the surgery done. Sixteen out of 20 patients in spreader group and 9 out of 20 in auto-spreader flap group.
Conclusion
Auto-spreader flap and spreader graft are very effective surgical procedure for treatment of nasal obstruction due to internal nasal valve dysfunction, but the auto-spreader flap had shorter operative time. However, spreader graft has a superior aesthetic outcome.
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22
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Wu Z, Krebs JP, Spector BM, Otto BA, Zhao K, Farag AA. Regional Peak Mucosal Cooling Predicts Radiofrequency Treatment Outcomes of Nasal Valve Obstruction. Laryngoscope 2020; 131:E1760-E1769. [PMID: 33140876 DOI: 10.1002/lary.29223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Low energy radiofrequency may offer effective treatment for narrow or obstructed nasal valve, yet its precise mechanism is not fully understood. STUDY DESIGN Prospective, nonrandomized, case series. METHODS Twenty prospective patients with internal nasal valve obstruction underwent office-based Vivaer treatment (Aerin Medical, Inc) under local anesthesia. Computational fluid dynamics (CFD) models were constructed based on the pre- and 90 days post-procedure computed tomography (CT) scans to identify salient changes in nasal airflow parameters. RESULTS Patients' Nasal Obstruction Symptom Evaluation score (NOSE: pre-treatment 78.89 ± 11.57; post-treatment 31.39 ± 18.30, P = 5e-7) and Visual Analog Scale of nasal obstruction (VAS: pre-treatment 6.01 ± 1.83; post-treatment 3.44 ± 2.11, P = 1e-4) improved significantly at 90 days after the minimally invasive approach. Nasal airway volume in the treatment area increased ~7% 90 days post-treatment (pre-treatment 5.97 ± 1.20, post-treatment 6.38 ± 1.50 cm3 , P = .018), yet there were no statistically significant changes in the measured peak nasal inspiratory flowrate (PNIF, pre-treatment: 60.16 ± 34.49; post-treatment: 72.38 ± 43.66 ml/s; P = .13) and CFD computed nasal resistance (pre-treatment: 0.096 ± 0.065; post-treatment: 0.075 ± 0.026 Pa/(ml/s); P = .063). As validation, PNIF correlated significantly with nasal resistance (r = 0.47, P = .004). Among all the variables, only the peak mucosal cooling posterior to the nasal vestibule significantly correlated with the NOSE at baseline (r = -0.531, P = .023) and with post-treatment improvement (r = 0.659, P = .003). CONCLUSION Minimal remodeling of the nasal valve (7% in this study) may have a profound effect on perceived nasal obstruction, despite little effect on nasal resistance, or PNIF. The results corroborated our previous findings that subjective relief of nasal obstruction correlates with regional mucosal cooling rather than nasal resistance or peak flow rate, a potential target for future effective, personalized therapeutic approaches. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1760-E1769, 2021.
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Affiliation(s)
- Zhenxing Wu
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Jillian P Krebs
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Barak M Spector
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kai Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Alexander A Farag
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, U.S.A
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23
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Hosseini S, Schuman TA, Golshahi L. Correlations to Estimate the Key Anatomical Dimensions of Pediatric Nasal Airways using Minimally Invasive Measurements of Intranasal Pressure Gradient. J Aerosol Med Pulm Drug Deliv 2020; 34:171-180. [PMID: 32833574 DOI: 10.1089/jamp.2019.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding the morphology of nasal airways is important in determining the nasal airway deposition of inhaled aerosol. Moreover, objective assessment of the anatomy of human nasal airways is useful to develop a database of reference or normal values as a resource to investigate anatomical abnormalities of airways. Current methods for the objective assessment of the nasal airways are either limited to very few dimensions or can only be performed by specialized researchers. Thus, the main objective of this study was to determine the correlations between the intranasal pressure gradient (Δp) and the key anatomical dimensions of the pediatric nasal airways, which could in turn allow the extrapolation of nasal airway morphology based on simple minimally invasive measurements of pressure. Methods: The anatomical data and Δp were obtained from in vitro studies with nasal airway models of 11 infants ages 3-18 months and 13 children ages 4-14 years old. Key anatomical dimensions were identified based on both rhinology and aerosol dosimetry literature. These anatomic data, including the volume, V, surface area, As, length, L, and the minimum cross-sectional area of the replicas, Amin, were then analyzed for correlation with Δp and flow parameters, using Bernoulli's principle and dimensional analysis. Results: Strong correlations were found between Δp and As/L for children, and between Δp and V/As for infants. Additional pressure gradient correlations were developed with Amin, V/As, V∕L, and L. Conclusions: The correlations identified between anatomic data and Δp have clinical implications in pediatric rhinology, suggesting that certain aspects of airway anatomy in infants and children can be predicted through the measurement of Δp. The airway dimensions, predicted using Δp measurement, may be used in tandem with aerosol nasal deposition correlations that account for nasal airway dimensions.
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Affiliation(s)
- Sana Hosseini
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia, USA
| | - Theodore A Schuman
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laleh Golshahi
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia, USA
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Calvo-Henriquez C, Capasso R, Martínez-Capoccioni G, Rangel-Chaves J, Liu SY, O'Connor-Reina C, Lechien JR, Martin-Martin C. Safeness, subjective and objective changes after turbinate surgery in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 135:110128. [PMID: 32485468 DOI: 10.1016/j.ijporl.2020.110128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Inferior turbinates are the main structure related to impaired nasal breathing. When medical treatment fails, surgery is the next step, according to clinical guidelines. However, despite the widespread acceptance of this procedure, there is some controversy about performing it in children. DATA SOURCES Pubmed (Medline), the Cochrane Library, EMBASE, Scopus, Science direct, SciELO and Trip Database. REVIEW METHODS We looked for articles in which the individual outcome of turbinate surgery in pediatric patients was investigated independently of whether it was the main objective of the study or not. RESULTS 13 papers (1111 patients) met the inclusion criteria. 6 authors performed diverse objective assessment and 11 authors used subjective scales. All of them found improvement after surgery. Due to the heterogeneity of the methods used, they could not be included in a metanalysis. Eleven out of the 13 authors reported 3.12% complication rates, being minor bleeding the most common (1.30%), followed by crust (0.49%) and pain (0.47%). CONCLUSIONS There is a lack of high quality studies in children. Turbinate surgery in children is a safe technique with low complication rates. The available evidence suggests improvement in subjective outcomes after turbinate surgery in children. We cannot make a formal recommendation of a surgical technique in children given the lack of high quality studies, and since comparison between available papers is not possible. Although the evidence at our disposal is weak, it suggests that the safest techniques are MAIT, radiofrequency, coblation and laser.
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Affiliation(s)
- Christian Calvo-Henriquez
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain.
| | - Robson Capasso
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | - Gabriel Martínez-Capoccioni
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Jesús Rangel-Chaves
- Department of Otolaryngology, Hospital Nuestra Señora de La Salud, San Luis de Potosi, Mexico
| | - Stanley Yung Liu
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | | | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Martin-Martin
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology, University of Santiago de Compostela, Spain
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25
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Stefani K, Baxter C, Crittenden T, Dean NR. Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population. ANZ J Surg 2020; 90:2304-2309. [PMID: 32419225 DOI: 10.1111/ans.15990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent changes to the Australian Medicare Benefits Scheme have introduced the NOSE Score as a criteria threshold for funding rhinoplasty. On review of the literature, however, there is minimal normative Nasal Obstruction Symptom Evaluation (NOSE) score data to provide context for these changes. METHODS Participants were recruited according to the general Australian population distribution of age (18-65 years), gender and geographical locations using the market research company Pureprofile. The data included demographic details, risk factors for nasal obstruction such as smoking, obstructive sleep apnoea, use of continuous positive airway pressure, history of nasal trauma, operations to the nose and a history of cleft lip/palate and each participant completed the NOSE Scale. Analysis of data included descriptive statistics, independent t-tests and one-way analysis of variances to assess differences in NOSE scores between risk factors. RESULTS The NOSE score was completed by 247 males and 255 females with a mean age of 41(±13.39) years. The cohort had a mean NOSE score of 16 (±18.89) with a range from 0 to 95. A total of 48 respondents had a NOSE score greater than the Medicare threshold of >45. Cleft lip/palate, obstructive sleep apnoea and continuous positive airway pressure use were shown to have a statistically significant impact on NOSE score while other variables including body mass index, gender, smoking, location and other surgery to the nose were not shown to significantly impact results. CONCLUSIONS This study found that 9.6% of the general Australian population would have a NOSE score >45 and qualify for the Medicare Benefits Scheme rhinoplasty benefit.
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Affiliation(s)
- Kristian Stefani
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Claire Baxter
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tamara Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Okland TS, Kandathil C, Sanan A, Rudy S, Most SP. Analysis of Nasal Obstruction Patterns Following Reductive Rhinoplasty. Aesthetic Plast Surg 2020; 44:122-128. [PMID: 31463565 DOI: 10.1007/s00266-019-01484-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cosmetic rhinoplasty has been linked to iatrogenic breathing disturbances using clinical tools. However, few studies have evaluated outcomes using validated, patient-centered instruments. OBJECTIVE We aim to determine the incidence and severity of nasal obstruction following cosmetic rhinoplasty as measured by patient-centered, disease-specific instruments. DESIGN This is a retrospective review of adult patients who underwent cosmetic rhinoplasty at Stanford Hospital between January 2017 and January 2019. General demographic as well as Nasal Obstruction and Symptom Evaluation (NOSE) and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaire data were included. Scores were tracked across postoperative visits and compared to the preoperative state. Patients were subdivided into dorsal hump takedown, correction of the nasal tip, and both. RESULTS Of the 68 included patients, 56 were women, and the mean age was 30.6 years. Although mean SCHNOS and NOSE scores increased at the first postoperative interval, mean scores decreased on each subsequent visit. There were no significant increases in SCHNOS or NOSE scores for either dorsal hump takedown, tip correction, or both. There were only two patients who recorded NOSE scores higher than baseline at most recent postoperative visit. CONCLUSION Our results indicate reductive rhinoplasty is not associated with a greater risk of breathing obstruction when performed with modern airway preservation techniques. The initial increases in obstructive symptoms we observed on the first postoperative visit likely represent perioperative swelling given the improvement on follow-up visits. Both the NOSE and SCHNOS are patient-centered questionnaires capable of evaluating nasal obstruction following cosmetic rhinoplasty. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Gruber RP, Lentz R. Invited Discussion on: Analysis of Nasal Obstruction Patterns Following Reductive Rhinoplasty. Aesthetic Plast Surg 2020; 44:129-130. [PMID: 31637501 DOI: 10.1007/s00266-019-01508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Kandathil CK, Rudy SF, Moubayed SP, Most SP. Lateral Wall Insufficiency Severity and Patient-Reported Nasal Obstruction Measures. JAMA FACIAL PLAST SU 2019; 20:427-428. [PMID: 29710296 DOI: 10.1001/jamafacial.2018.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cherian K Kandathil
- Division of Facial Plastic Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Shannon F Rudy
- Division of Facial Plastic Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Sami P Moubayed
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Québec, Canada
| | - Sam P Most
- Division of Facial Plastic Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
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Abstract
Importance Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted. Objective To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair. Design, Setting, and Participants This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016. Intervention Open septorhinoplasty. Main Outcomes and Measures Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades. Results Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI. Conclusions and Relevance The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period. Level of Evidence 3.
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Affiliation(s)
- Reza Vaezeafshar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Sami P Moubayed
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California
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Vanhille DL, Garcia GJM, Asan O, Borojeni AAT, Frank-Ito DO, Kimbell JS, Pawar SS, Rhee JS. Virtual Surgery for the Nasal Airway: A Preliminary Report on Decision Support and Technology Acceptance. JAMA FACIAL PLAST SU 2019; 20:63-69. [PMID: 29049474 DOI: 10.1001/jamafacial.2017.1554] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery. Objective To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. Design, Setting, and Participants For this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. Main Outcomes and Measures Likert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making. Results Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. Conclusions and Relevance Our study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction. Level of Evidence NA.
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Affiliation(s)
- Derek L Vanhille
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Onur Asan
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Azadeh A T Borojeni
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee.,Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee
| | - Dennis O Frank-Ito
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina.,Computational Biology & Bioinformatics Program, Duke University, Durham, North Carolina.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Strazdins E, Nie YF, Ramli R, Palesy T, Christensen JM, Alvarado R, Marcells GN, Harvey RJ. Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty. JAMA FACIAL PLAST SU 2019; 20:284-291. [PMID: 29450446 DOI: 10.1001/jamafacial.2018.0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mental health can have an impact on patient satisfaction with rhinoplasty. However, the association between mental health and patient satisfaction with functional outcomes of rhinoplasty is poorly understood. Objective To determine whether preoperative mental health is associated with satisfaction with functional outcomes of rhinoplasty. Design, Setting, and Participants This case-control study assessed baseline nasal function and postsurgical functional outcomes for 88 consecutive patients undergoing rhinoplasty with both cosmetic and functional goals at 2 tertiary rhinologic centers in Sydney, Australia. Exposures Poor mental well-being was defined preoperatively by the Optum SF-36v2 Health Survey mental component summary. Main Outcomes and Measures Nasal function was assessed with patient-reported outcome measures, including visual analog scales, the Nasal Obstruction Symptom Evaluation Scale (NOSE), the 22-item Sinonasal Outcome Test (SNOT-22), and Likert scales. Objective outcomes included nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. All outcomes were assessed preoperatively and 6 months postoperatively. The 36-item Optum SF-36v2 Health Survey mental component summary was used to assess mental well-being, with a score of less than 40 indicating poor mental well-being and a score 40 or higher indicating normal well-being. Results Mean (SD) patient age was 37.6 (12.9) years and 53 of 88 (60.2%) were women. The mental component summary defined impaired well-being in n = 24 (cases) and normal well-being in n = 64 (controls). There were improvements in the total study population across most nasal function outcomes and in both groups. After rhinoplasty, benefit was seen for both groups in visual analog scale (left side mean [SD] change, 18 [30]; P < .001 and right side mean [SD] change, 24 [30]; P < .001); NOSE (mean [SD] change, 1.35 [1.21]; P < .001); and SNOT-22 (mean [SD] change, 0.81 [0.88]; P < .001) scores. Nasal peak inspiratory flow improved for both groups (mean [SD] change, 32 [45] L/min; P < .001), while nasal airway resistance and minimum cross-sectional area remained similar (change in nasal airway resistance, 0.086 Pa/cm3/s; 95% CI, -0.007 Pa/cm3/s to 0.179 Pa/cm3/s and change in minimum cross-sectional area, -0.04 cm2; 95% CI, -0.21 cm2 to 0.13 cm2). Patients with poor mental health had similar improvements in nasal function compared with controls. Conclusions and Relevance Rhinoplasty imparts similar benefits to nasal function assessed by patient-reported outcome measures and objective airflow measures regardless of preoperative mental health status. Level of Evidence 3.
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Affiliation(s)
- Erika Strazdins
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Yu Feng Nie
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raziqah Ramli
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Tom Palesy
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jenna M Christensen
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | | | - Richard J Harvey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Brandon BM, Austin GK, Fleischman G, Basu S, Kimbell JS, Shockley WW, Clark JM. Comparison of Airflow Between Spreader Grafts and Butterfly Grafts Using Computational Flow Dynamics in a Cadaveric Model. JAMA FACIAL PLAST SU 2019; 20:215-221. [PMID: 29242911 DOI: 10.1001/jamafacial.2017.1994] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal valve compromise is a major cause of nasal obstruction, and multiple methods have been developed to address it. Objective To compare nasal airflow resistance, airflow partitioning, and mucosal cooling (heat flux) before and after 2 surgical interventions, butterfly and spreader graft placement, used to treat nasal valve compromise. Design, Setting, and Participants In this cadaveric tissue study, 4 fresh cadaveric heads underwent both spreader graft and butterfly graft surgical procedures in alternating sequence in March 2016. Preoperative and postoperative computed tomographic scans were used to generate 3-dimensional (3-D) models of the nasal airway. These models were then used in steady state computational fluid dynamics simulations of airflow and heat transfer during inspiration. Intervention Butterfly and spreader graft techniques. Main Outcomes and Measures Nasal airflow resistance, airflow partitioning, and heat flux. Results Donors 1, 2, and 3 were white males; donor 4, a white female. Computational fluid dynamics simulations during inspiration in 3-D models generated from preoperative and postoperative computed tomographic scans of the 4 cadaveric heads indicated reductions from preoperative values in nasal airflow resistance associated with both butterfly grafts (range, 20%-51%) and spreader grafts (range, 2%-29%). Butterfly grafts were associated with a greater reduction in nasal airflow resistance in models of all 4 cadaveric heads. Changes from preoperative values for heat flux, a biophysical variable that correlates with the subjective sensation of nasal patency, were more variable, ranging from -11% to 4% following butterfly grafts and -9% to 10% following spreader grafts. The preoperative airflow allocation in the left and right nostrils improved consistently with the butterfly graft. With the spreader graft, there were improvements for donors 1 and 4, but the allocations were worse for donors 2 and 3. Conclusions and Relevance The results of this study suggest that the more recently developed butterfly graft technique may be associated with a similar level of improved nasal airflow as that observed with the use of a spreader graft in nasal valve compromise. Both interventions were associated with comparable changes in heat flux. Because this study addressed only static internal nasal valve stenosis, even greater differences in air flow and heat flux between the 2 techniques may be anticipated in a dynamic model. Further investigation in patients is warranted. Level of Evidence NA.
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Affiliation(s)
- Bryan M Brandon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Grace K Austin
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Gita Fleischman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Saikat Basu
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - Julia S Kimbell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - William W Shockley
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
| | - J Madison Clark
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill
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Nascimento JA, Genta PR, Fernandes PHS, Barroso LP, Carvalho TS, Moriya HT, Madeiro F, Lorenzi-Filho G, Nakagawa NK. Predictors of oronasal breathing among obstructive sleep apnea patients and controls. J Appl Physiol (1985) 2019; 127:1579-1585. [PMID: 31465714 DOI: 10.1152/japplphysiol.00964.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP.NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.
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Affiliation(s)
- Juliana A Nascimento
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro R Genta
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo H S Fernandes
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia P Barroso
- Departament of Statistics, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | - Tômas S Carvalho
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Henrique T Moriya
- Biomedical Engineering Laboratory, Telecommunication and Control Engineering Department, Escola Politécnica da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Madeiro
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Sanan A, Most SP. A Bioabsorbable Lateral Nasal Wall Stent for Dynamic Nasal Valve Collapse: A Review. Facial Plast Surg Clin North Am 2019; 27:367-371. [PMID: 31280850 DOI: 10.1016/j.fsc.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nasal obstruction is one of the most common clinical problems encountered by otolaryngologists and facial plastic surgeons. Lateral wall insufficiency (LWI) is a key anatomic contributor to nasal obstruction. Traditional techniques for correcting LWI include alar batten grafts, bone-anchored sutures, and lateral crural strut grafts. Latera is an absorbable nasal implant that can be inserted in the office or the operating room as an adjunctive procedure for LWI. The purpose of this review is to discuss Latera, a novel bioabsorbable implant to improve the nasal airway.
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Affiliation(s)
- Akshay Sanan
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Sam P Most
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA; Department of Surgery (Plastic Surgery), Fellowship in Facial Plastic & Reconstructive Surgery, Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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Gökçe Kütük S, Arıkan OK. Evaluation of the effects of open and closed rhinoplasty on the psychosocial stress level and quality of life of rhinoplasty patients. J Plast Reconstr Aesthet Surg 2019; 72:1347-1354. [PMID: 31078414 DOI: 10.1016/j.bjps.2019.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
AIM To investigate patient-reported functional and aesthetic outcomes and psycho-social distress levels in patients undergoing rhinoplasty with regard to technique, type, and indications of surgery. METHODS A total of 90 patients (mean(SD) age: 27.4(6.5) years, 64.4% females) undergoing rhinoplasty were included prospectively. Data of Nasal Symptom Obstruction Evaluation (NOSE) scale for the functional outcome, the rhinoplasty outcome evaluation (ROE) scale for the esthetic outcome, and the Derriford Appearance Scale (DAS-24) for psychosocial outcomes were recorded preoperatively and in the postoperative 1st, 3rd, and 6th month. RESULTS No significant difference was noted in ROE or NOSE scores with regard to technique (open vs. closed), type (primary vs. secondary), and indication (functional vs. cosmetic) of rhinoplasty during study visits. Open vs. closed surgery, secondary vs. primary rhinoplasty, and cosmetic vs. functional indication for rhinoplasty were associated with significantly higher DAS-24 scores at the preoperative visit (p < 0.001 for each) and postoperative 1st (p < 0.001 for each) and 3rd month (p < 0.001, p < 0.001, and p < 0.01, respectively) visits. NOSE, ROE, and DAS-24 scores significantly decreased from the preoperative to the postoperative period and from 1st month to 3rd and 6th months of postoperative follow-up in all patients, regardless of the rhinoplasty subgroup (p < 0.001 for each). CONCLUSION In conclusion, our findings revealed favorable postoperative functional and esthetic outcome and improved psycho-social distress in patients undergoing rhinoplasty, with significantly improved NOSE, ROE, and DAS-24 scores after rhinoplasty during the entire 6-month follow-up, regardless of the technique (open vs. closed), type (primary vs. revision), and indication (cosmetic vs. functional) of rhinoplasty. Closed rhinoplasty may be a more preferable method because of less psycho-social distress.
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Affiliation(s)
| | - Osman Kürşat Arıkan
- Department of Otorhinolaryngology, University of Health Sciences, Adana Teaching and Research Hospital, Adana, Turkey
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Howard BE, Madison Clark J. Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications. Laryngoscope 2019; 129:S1-S10. [DOI: 10.1002/lary.27776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Brittany E. Howard
- Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive SurgeryMayo Clinic Phoenix Arizona
| | - J. Madison Clark
- Department of Otolaryngology–Head and Neck Surgery, Division of Facial Plastic and Reconstructive SurgeryUniversity of North Carolina Chapel Hill North Carolina U.S.A
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Gu JT, Kaplan S, Greenfield S, Calloway H, Wong BJF. Validation of a septoplasty deformity grading system for the evaluation of nasal obstruction. Laryngoscope 2018; 129:586-593. [PMID: 30467854 DOI: 10.1002/lary.27365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS We developed and validated a septal deformity grading (SDG) system that accounts for anatomic location and grading of deformity severity. STUDY DESIGN Retrospective cohort study. METHODS Subjects were patients with nasal obstruction presenting to University of California, Irvine Medical Center. Subjects were given pre- and postoperative Nasal Obstruction Symptom Evaluation (NOSE) questionnaires and were evaluated by a facial plastic surgeon using our septal deformity grading (SDG) system. Validity and reliability analyses were conducted on the SDG results. Statistical analyses were conducted on SDG and NOSE data to assess and compare instruments, and to validate the SDG instrument using the NOSE instrument. RESULTS One hundred thirty-five patients met inclusion criteria. Cronbach's α was ≥ 0.7 for SDG and pre- and postoperative NOSE scores. There was a significant difference in pre- and postoperative NOSE scores (Z score = -7.21, P < .001). Correlations between postoperative NOSE and SDG scores were significant (P = .014), and convergent construct validity was achieved. There was a significant difference in SDG scores between primary versus revision operations (P < .001), history versus no history of nasal trauma, and nasal/septal surgery (P = .025, P = .003, respectively). The odds of having a revision operation were 2.3 times higher for high SDG scores (P < .001), of having a history of nasal trauma were 1.33 times higher for high SDG scores (P = .014), and of having a history of nasal/septal surgery were 2.9 times higher for low SDG scores. CONCLUSIONS Our SDG system addresses the challenge of providing objective anatomic information on the severity of nasal septal deformities, and may be valuable when used in conjunction with subjective data gathered from the NOSE questionnaire. LEVEL OF EVIDENCE 4 Laryngoscope, 129:586-593, 2019.
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Affiliation(s)
- Jeffrey T Gu
- Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A.,Beckman Laser Institute, Irvine, California, U.S.A.,School of Medicine
| | - Sherrie Kaplan
- School of Medicine.,Health Policy Research Institute, University of California Irvine, Irvine, California, U.S.A
| | - Sheldon Greenfield
- School of Medicine.,Health Policy Research Institute, University of California Irvine, Irvine, California, U.S.A
| | - Hollin Calloway
- Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A
| | - Brian J F Wong
- Department of Otolaryngology-Head and Neck Surgery, Irvine, California, U.S.A.,Beckman Laser Institute, Irvine, California, U.S.A.,School of Medicine
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Fuller JC, Gadkaree SK, Levesque PA, Lindsay RW. Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty. Laryngoscope 2018; 129:594-601. [PMID: 30325509 DOI: 10.1002/lary.27566] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/08/2022]
Abstract
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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Affiliation(s)
- Jennifer C Fuller
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Patricia A Levesque
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Robin W Lindsay
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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Burgos MA, Sanmiguel-Rojas E, Rodríguez R, Esteban-Ortega F. A CFD approach to understand nasoseptal perforations. Eur Arch Otorhinolaryngol 2018; 275:2265-2272. [PMID: 30043077 DOI: 10.1007/s00405-018-5073-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function. METHODS We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R-[Formula: see text] based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP. RESULTS In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate [Formula: see text] through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of [Formula: see text] were found. CONCLUSION The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.
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Affiliation(s)
- M A Burgos
- Departamento de Ingeniería Térmica y de Fluidos, Universidad Politécnica de Cartagena, Cartagena, Spain
| | - E Sanmiguel-Rojas
- Departamento de Ingeniería Mecánica, Térmica y de Fluidos, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071, Malaga, Spain.
| | - R Rodríguez
- Servicio de Radiodiagnóstico, Servicio Andaluz de Salud, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - F Esteban-Ortega
- Servicio de Otorrinolaringología, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
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Abstract
Methods of measuring nasal obstruction outcomes include both objective anatomic and physiologic measurements, as well as subjective patient-reported measures. Anatomic measurements include acoustic rhinometry, imaging studies, and clinician-derived examination findings. Physiologic measures include rhinomanometry, nasal peak inspiratory flow, and computational fluid dynamics. Patient-reported outcome measures (PROMs) are self-reported assessments of disease-specific quality-of-life outcomes. Several studies attempted correlation of these outcome measures; however, few show strong correlation. Expert opinion favors determining successful surgical outcomes using PROMs. This review provides a summary of current nasal obstruction outcome measures.
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Affiliation(s)
- Emily Spataro
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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Stolovitzky P, Sidle DM, Ow RA, Nachlas NE, Most SP. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: Outcomes using a bioabsorbable implant. Laryngoscope 2018; 128:2483-2489. [PMID: 29756407 PMCID: PMC6585764 DOI: 10.1002/lary.27242] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/21/2018] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine 6-month outcomes for treatment of lateral nasal wall insufficiency with a bioabsorbable implant. STUDY DESIGN Prospective, multicenter, nonrandomized, single-blinded study. METHODS One hundred and one patients with severe-to-extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 14 U.S. clinics (September 2016-March 2017). Patients were treated with a bioabsorbable implant designed to support lateral wall, with or without concurrent septoplasty and/or turbinate reduction procedure(s). NOSE scores and visual analog scale (VAS) were measured at baseline and month 1, 3, and 6 postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video. RESULTS Forty-three patients were treated with implant alone, whereas 58 had adjunctive procedures. Seventeen patients reported 19 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores at 1, 3, and 6 months postoperatively (79.5 ± 13.5 preoperatively, 34.6 ± 25.0 at 1 month, 32.0 ± 28.4 at 3 months, and 30.6 ± 25.8 at 6 months postoperatively; P < 0.01 for all). They also showed significant reduction in VAS scores postoperatively (71.9 ± 18.8 preoperatively, 32.7 ± 27.1 at 1 month, 30.1 ± 28.3 at 3 months, and 30.7 ± 29.6 at 6 months postoperatively; P < 0.01 for all). These results were similar in patients treated with the implant alone compared to those treated with the implant and adjunctive procedures. Consistent with patient-reported outcomes, postoperative LWI scores were demonstrably lower (1.83 ± 0.10 and 1.30 ± 0.11 pre- and postoperatively; P < 0.01). CONCLUSION Stabilization of the lateral nasal wall with a bioabsorbable implant improves patients' nasal obstructive symptoms over 6 months. LEVEL OF EVIDENCE 2b. Laryngoscope, 2483-2489, 2018.
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Affiliation(s)
- Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville
| | - Nathan E Nachlas
- Ear, Nose and Throat Associates of South Florida, Boca Raton, Florida
| | - Sam P Most
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Castano R, Thériault G, Gautrin D, Ghezzo H, Trudeau C, Malo JL. Reproducibility of Acoustic Rhinometry in the Investigation of Occupational Rhinitis. ACTA ACUST UNITED AC 2018; 21:474-7. [PMID: 17882918 DOI: 10.2500/ajr.2007.21.3039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background To diagnose occupational rhinitis, it is mandatory to conduct an objective assessment of changes in nasal patency during specific inhalation challenge (SIC). The reproducibility of acoustic rhinometry measurements in the setting of occupational challenges has never been examined. This study assessed the reproducibility of acoustic rhinometry during SIC investigation of occupational rhinitis. Methods Twenty-four subjects underwent acoustic rhinometry measurements during SIC investigation of occupational rhinitis. Subjects attended 3–6 days of SIC within a week by means of a realistic or closed-circuit apparatus methodology Results All of the within-day intraclass correlation coefficients (ICCs) for nasal volume (2–5 cm) and minimum cross-sectional area (MCA) based on a different number of measurements (2–7) were above 0.85; all of the coefficients of variation (CVs) for the same parameters were low (below 10%). The between-day CVs based on different numbers of SIC sessions ranged from 8.0 to 8.8% and from 6.8 to 8.8% for nasal volume and MCA, respectively. The between-day ICCs ranged from 0.80 to 0.88 and from 0.83 to 0.94 for nasal volume and MCA, respectively. Conclusion Acoustic rhinometry showed good within- and between-day reproducibility and can be recommended for the objective monitoring of nasal patency during SIC investigating occupational rhinitis.
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Affiliation(s)
- Roberto Castano
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Tahamiler R, Yener M, Canakcioglu S. Efficacy of Odiosoft-Rhino in Assessment of Nasal Obstruction: A Comparative Study with Acoustic Rhinometry after Treatment with Budesonide Nasal Spray in Patients with Perennial Allergic Rhinitis. ACTA ACUST UNITED AC 2018; 21:711-5. [DOI: 10.2500/ajr.2007.21.3106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Odiosoft-Rhino (OR) is new software and equipment that can be used to measure changes in nasal obstruction after intranasal steroid treatment. OR is a promising method for measuring the degree of nasal obstruction. OR can precisely analyze nasal sound spectra in decibels, which is generated by nasal airflow. We studied the reliability of OR for assessing declining nasal obstruction after budesonide nasal spray treatment. Methods Sixty-five patients with perennial allergic rhinitis (PAR) were enrolled in the study, and 52 of these patients completed the study. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores were compared before and after 3 months of treatment with intranasal budesonide. All of the patients received 7 days of placebo treatment before receiving budesonide. Results There was a significant difference in the visual analog scores of nasal obstruction and in the examination scores before and after the treatment for both the right and the left nasal cavities. Pretreatment AR findings and OR findings in the 2000- to 4000-Hz and 4000-to 6000-Hz intervals for both sides were significantly different from the posttreatment measurements (p = 0.000). Both AR and OR can assess the efficacy of budesonide nasal spray treatment for nasal obstruction in patients with PAR. Conclusion Both AR and OR are effective for assessing nasal obstruction and monitoring treatment efficacy but, as a simple and noninvasive test, OR can be used with confidence.
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Affiliation(s)
- Rauf Tahamiler
- Department of Otorhinolaryngology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Murat Yener
- Department of Otorhinolaryngology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Salih Canakcioglu
- Department of Otorhinolaryngology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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Costa JG, Costa GS, Costa C, Vilella ODV, Mattos CT, Cury-Saramago ADA. Clinical recognition of mouth breathers by orthodontists: A preliminary study. Am J Orthod Dentofacial Orthop 2017; 152:646-653. [DOI: 10.1016/j.ajodo.2017.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
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Strazdins E, Nie YF, Ramli R, Palesy T, Christensen JM, Marcells GN, Harvey RJ. Association of Mental Health Status With Perception of Nasal Function. JAMA FACIAL PLAST SU 2017; 19:369-377. [PMID: 28727888 DOI: 10.1001/jamafacial.2017.0459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mental health issues are thought to be overrepresented among patients undergoing rhinoplasty and may be associated with patient presentation prior to surgery. Objective To assess the association of poor mental health with perception of nasal function. Design, Setting, and Participants A cross-sectional study of patients presenting for airway assessment was performed from December 1, 2011, to October 31, 2015, at 2 tertiary rhinoplasty centers in Sydney, Australia. Mental health was independently defined preoperatively by the Mental Component Summary of the 36-item Short Form Health Survey version 2 (a score of <40 indicated poor mental well-being), the Rosenberg Self-Esteem Scale (a score of <15 indicated low self-esteem), and the Dysmorphic Concerns Questionnaire (a score of >11 indicated above-average dysmorphic concerns). Main Outcomes and Measures Nasal function was assessed with patient-reported outcome measures, including the Nasal Obstruction Symptom Evaluation Scale, the 22-item Sinonasal Outcome Test, a visual analog scale to rate ease of breathing on the left and right sides, and Likert scales to assess overall function and nasal obstruction. Nasal airflow was assessed by nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. Results Among 495 patients in the study (302 women and 193 men; mean [SD] age, 36.5 [13.6] years), compared with patients with good mental health, those with poor mental health had poorer scores in all patient-reported outcome measures, including the visual analog scale for the left side (mean [SD], 51 [25] vs 42 [25]; P = .001), visual analog scale for the right side (mean [SD], 54 [24] vs 45 [26]; P < .001), Nasal Obstruction Symptom Evaluation Scale (mean [SD], 2.64 [0.95] vs 1.96 [1.04]; P < .001), 22-item Sinonasal Outcome Test (mean [SD], 2.14 [0.84] vs 1.33 [0.83]; P < .001), nasal obstruction (58 of 145 [40.2%] vs 83 of 350 [23.7%] with severe or worse obstruction; P < .001), and nasal function (72 of 145 [49.7%] vs 111 of 350 [31.8%] with poor or worse function; P < .001). Subclinical differences in nasal peak inspiratory flow could be demonstrated, but all other nasal airflow measures were similar. Low self-esteem produced a similar pattern, but dysmorphia did not. Conclusions and Relevance Poor mental health status is associated with a poorer self-perception of nasal function compared with those who are mentally healthy with clinically similar nasal airflow. Clinicians should be aware that patients with poor mental health reporting obstructed airflow may in part be representing an extension of their negative emotions rather than true obstruction and may require further assessment prior to surgery. Level of Evidence NA.
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Affiliation(s)
- Erika Strazdins
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Yu Feng Nie
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Raziqah Ramli
- Department of Medicine, University of New South Wales, Zetland, New South Wales, Australia
| | - Tom Palesy
- Faculty of Medicine, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Jenna M Christensen
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Darlinghurst, New South Wales, Australia
| | | | - Richard John Harvey
- Rhinology and Skull Base Surgery, St Vincent's Centre for Applied Medical Research, University of New South Wales, Darlinghurst, Sydney, New South Wales, Australia.,Rhinology and Skull Base Surgery, Macquarie University, New South Wales, Australia
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Dadgarnia M, Meybodian M, Karbasi A, Baradaranfar M, Atighechi S, Zand V, Vaziribozorg S. Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial. Eur Arch Otorhinolaryngol 2017; 274:3513-3518. [PMID: 28685311 DOI: 10.1007/s00405-017-4664-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
It has been shown that nasal packing after septoplasty is associated with several complications. Our aim was to compare post-septoplasty nasal packing and trans-septal suturing, in terms of complications and outcome of operation. This randomized clinical trial was performed on patients with deviated nasal septum who were candidates for septoplasty. Patients were visited three times after operation (on the first 48 h, first week, and third post-operative month). Participants were checked for having common complications. Rhinomanometric evaluation was performed to measure nasal air flow and airway resistance, as indicators of operation efficacy, both prior to and after surgery. A total of 72 patients were allocated into the two trial arms. Patients in nasal pack group reported higher pain scores on the first 48 h (P < 0.001) and one week after surgery (P < 0.001). Epiphora (P = 0.028), sleep disturbance (P = 0.012), and dyspnea (P < 0.001) were also more commonly observed in patients using nasal pack. Objective evaluation of bleeding demonstrated that more severe bleeding occurred in patients with trans-septal sutures (P = 0.001). No differences were found comparing the indices of rhinomanometry between the two groups. Using trans-septal sutures after septoplasty compared to nasal packing, might be associated with lower frequencies of several specific complications and a lower rate of patients' discomfort. Nevertheless, increase in the risk of bleeding and hematoma was noted in the trans-septal suture group. No differences were observed between the nasal air flow and resistance of patients in the two groups.
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Affiliation(s)
- Mohammadhossein Dadgarnia
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Meybodian
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Akbar Karbasi
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadhossein Baradaranfar
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeid Atighechi
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Vahid Zand
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sedighe Vaziribozorg
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Assessment of Nasal Obstruction With Rhinomanometry and Subjective Scales and Outcomes of Surgical and Medical Treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.otoeng.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fuller JC, Levesque PA, Lindsay RW. Assessment of the EuroQol 5-Dimension Questionnaire for Detection of Clinically Significant Global Health-Related Quality-of-Life Improvement Following Functional Septorhinoplasty. JAMA FACIAL PLAST SU 2017; 19:95-100. [PMID: 27893020 DOI: 10.1001/jamafacial.2016.1410] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal airway obstruction is a common presenting complaint among patients in otolaryngology practices, and its treatment necessitates critical outcomes evaluation and cost-utility analysis. Objective To evaluate the utility and applicability of the EuroQol 5-Dimension (EQ5D) global health-related quality-of-life (HRQoL) questionnaire for the assessment of clinical outcomes in functional septorhinoplasty. Design, Setting, and Participants Prospective cohort study at a university-based tertiary medical center of patients undergoing functional septorhinoplasty for treatment of nasal obstruction. Interventions Patient demographic characteristics, operative intervention, and preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) and EQ5D scores were collected and analyzed between November 2013 and June 2016. Main Outcomes and Measures Comparison of preoperative and postoperative EQ5D and NOSE scores at 2 and 6 or more months following surgery (long-term follow-up). Results A total of 135 patients (56.3% male; mean [SD] age, 36.8 [14.8] years) completed EQ5D and NOSE surveys preoperatively and postoperatively, with mean (SD) follow-up of 5.82 (4.1) months. Of these, 117 completed the 2-month survey and 64 completed their last survey at 6 or more months. Baseline NOSE and EQ5D visual analog scale (VAS) scores were moderately correlated (r = -0.37, P < .001) as were changes in NOSE and EQ5D VAS scores at long-term follow-up (r = -0.33, P = .007). Mean baseline NOSE score of 64.3 (95% CI, 60.5-68.2) decreased to 24.8 (95% CI, 18.8-30.9) at long-term follow-up (P < .001). The frequency of patients reporting problems in the EQ5D domains of pain/discomfort and usual activity decreased by more than half in the long-term follow-up group (30 [47%] vs 14 [22%] and 11 [17%] vs 4 [6%]; P = .002 and .02, respectively). The minimal clinically important difference of the EQ5D VAS score was calculated at 9.5. The EQ5D VAS scores had statistically and clinically significant improvement at long-term follow-up in patients with NOSE score improvements of 30 to 60 points (EQ5D VAS increased from mean [SD] of 72.3 [20] to 85.9 [10]; P < .001) and 65 to 100 points (EQ5D VAS increased from mean [SD] of 66.2 [25] to 82.0 [13]; P = .01). Conclusions and Relevance The EQ5D, a global HRQoL instrument, was able to detect clinically significant improvement following functional septorhinoplasty for nasal obstruction. Nasal valve correction improved not only disease-specific quality of life but also global HRQoL. The ability to calculate health utility values from the EQ5D and its low response burden make it an attractive tool for septorhinoplasty outcomes research. Level of Evidence 4.
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Affiliation(s)
- Jennifer C Fuller
- Massachusetts Eye and Ear Infirmary, Boston2Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Patricia A Levesque
- Massachusetts Eye and Ear Infirmary, Boston2Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Robin W Lindsay
- Massachusetts Eye and Ear Infirmary, Boston3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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Teti VP, Akdagli S, Most SP. Cost-effectiveness of Corticosteroid Nasal Spray vs Surgical Therapy in Patients With Severe to Extreme Anatomical Nasal Obstruction. JAMA FACIAL PLAST SU 2017; 18:165-70. [PMID: 26747790 DOI: 10.1001/jamafacial.2015.2039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Health insurance companies commonly require a trial of corticosteroid nasal spray prior to authorizing nasal surgery, even in patients with severe to extreme anatomical nasal obstruction, despite lack of data supporting such medical therapy. OBJECTIVES To provide a model for the comparative analysis of medical vs surgical treatment for nasal obstruction to help maximize health care benefit per dollar spent and to explore the cost-effectiveness of corticosteroid nasal spray in patients with severe to extreme nasal airway obstruction on Nasal Obstruction Symptom Evaluation (NOSE) scores. DESIGN, SETTING, AND PARTICIPANTS A cost-efficiency frontier economic evaluation was performed. The economic perspective was that of the health care third-party payer. Effectiveness data were obtained from NOSE score questionnaires in 179 patients. An incremental cost-effectiveness ratio was determined from the cost and efficacy data. Comparative treatment groups were medical therapy with corticosteroid nasal spray vs surgical therapy for nasal airway obstruction. The study was conducted between January 1, 2011, and December 30, 2013. The time horizon included 1, 2, and 5 years. Data analysis was completed June 1, 2015. MAIN OUTCOMES AND MEASURES The primary outcome was cost per quality-adjusted life-year (QALY). A modified Markov decision tree model was used. Costs were obtained from the Medicare 2015 physician fee schedule, and the mean was determined (owing to geographic disparity) along with wholesale and generic pharmaceutical pricing. RESULTS Among 100 men and 79 women evaluated (mean [SD] age, 37.9 [12.9] years), surgical repair of severe nasal airway obstruction cost $6537 and produced a total of 1.15 QALYs at 1 year. Medical treatment involved a trial of corticosteroid nasal sprays, which cost $520 and produced a total of 1.03 QALYs. The surgical approach was markedly more effective but at greater short-term cost. In cases of extreme nasal obstruction, medical treatment cost $520.73 with 1.004 QALYs, demonstrating an incremental cost-effectiveness ratio (ICER) of $354 693 per QALY compared with no treatment. Conversely, surgical treatment cost $6536.64 and produced 1.136 QALYs, with an ICER of $45 633 compared with medical therapy. At 5 years, the ICER decreased from $45 634 to $8110 per QALY for surgical treatment of extreme nasal obstruction. The medical treatment ICER decreased from $354 693 per QALY at 1 year to $273 704 per QALY at 5 years. An ICER was performed and demonstrated a cost threshold of $50 554 per QALY for surgical treatment compared with $67 518 per QALY for medical treatment at 1 year for severe nasal obstruction. If the evaluation is extended to 5 years, surgical treatment cost $8984 per QALY compared with $52 571 per QALY for medical treatment. Owing to the improved effectiveness outcomes, greater cost savings per ICER was demonstrated in patients with extreme nasal obstruction. CONCLUSIONS AND RELEVANCE Surgical treatment for patients with severe to extreme anatomical nasal obstruction demonstrates increased short-term expense but is cost-effective in the long term. These data suggest that treatment with corticosteroid nasal spray in patients with documented severe to extreme anatomical nasal obstruction is unnecessary and results in a delay in treatment. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Virginia P Teti
- Division of Facial Plastic & Reconstructive Surgery, School of Medicine, Stanford University, Stanford, California
| | - Seden Akdagli
- Division of Facial Plastic & Reconstructive Surgery, School of Medicine, Stanford University, Stanford, California
| | - Sam P Most
- Division of Facial Plastic & Reconstructive Surgery, School of Medicine, Stanford University, Stanford, California
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