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The Effect of Nasal Obstruction After Different Nasal Surgeries Using Acoustic Rhinometry and Nasal Obstruction Symptom Evaluation Scale

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The Effect of Nasal Obstruction After Different Nasal Surgeries Using Acoustic Rhinometry and Nasal Obstruction Symptom Evaluation Scale 236 Nasal obstruction after nasal surgeries Original Article The Effect of Nasal Obstruction after Different Nasal Surgeries Using Acoustic Rhinometry and Nasal Obstruction Symptom Evaluation Scale Erkan Kahraman1, Yakup Cil2*, Armagan Incesulu3 1. Department of Otorhinolaryngology, ABSTRACT Eskisehir Military Hospital, Eskisehir, Turkey; BACKGROUND 2. Department of Plastic, Reconstructive and The efficiency of nasal surgeries can be determined by objective Aesthetic Surgery, Etimesgut Military Hospital, Ankara, Turkey; or subjective methods. We have assessed the effect of nasal 3. Department of Otorhinolaryngology, obstruction after different nasal surgeries using Acoustic Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey Rhinometry (AR) and Nasal Obstruction Symptom Evaluation (NOSE) Scale. METHODS Between May 2011 and May 2012, 40 young adult patients and 10 healthy volunteers as control group who referred to Otorhinolaryngology Clinic in Eskisehir Military Hospital due to nasal obstruction were enrolled. Depending on operation, patients were divided into four equal groups. Group 1: Septoplasty, Group 2: Septoplasty with sprader graft, Group 3: Septorinoplasty and Group 4: Septorhinoplasty with spreader graft. The patients completed NOSE scale, 1 week before and 1 month after the surgery and AR measurements. RESULTS There were a significant improvement in mean NOSE scores of patients and statistical difference was found between pre and Downloaded from wjps.ir at 3:13 +0330 on Tuesday March 10th 2020 post-operational values for each group. There was a statistically significant change of the mean minimal cross section areas (MCA) of the deviated side of nasal passages measured by AR between pre and postoperative period. CONCLUSION In patients with nasal obstruction, functional nasal surgeries which were performed after appropriate medical examination and with right operation methods had a positive impact on quality of life and patient satisfaction. We observed that nasal findings were correlated with NOSE scores and MCA values. So, we suggest that NOSE scale and AR to be used for evaluation of the efficiency of functional nasal surgeries. *Corresponding Author: Yakup Cil, MD; KEYWORDS Associate Professor of Department of Nasal obstruction, nasal surgery, acoustic rhinometry, NOSE Plastic, Reconstructive and Aesthetic Surgery, Etimesgut Military Hospital, scale Ankara, Turkey. Please cite this paper as: E-mail: [email protected] Kahraman E, Cil Y, Incesulu A. The Effect of Nasal Obstruction Received: December 5, 2015 after Different Nasal Surgeries Using Acoustic Rhinometry and Revised: June 11, 2016 Nasal Obstruction Symptom Evaluation Scale. World J Plast Surg Accepted: August 10, 2016 2016;5(3):236-243. www.wjps.ir /Vol.5/No.3/September 2016 Kahraman et al. 237 In this study, we aimed to evaluate of the increase INTRODUCTION in life quality of young adult patients among the ones who suffered from nasal obstruction and Nasal obstruction is one of the most common were subjected to 4 different nasal surgeries problems in otolaryngology practice. Nasal including septoplasty, septoplasty with spreader obstruction can be caused by several factors graft, septorhinoplasty and septorhinoplasty such as deviation of nasal septum, nasal valve with spreader graft by using objective (AR) and collapse, turbinate hypertrophy and nasal subjective (NOSE scale) methods. polyposis.1 Among them, septum deviation is the main etiologic factor and more than half of MATERIALS AND METHODS the population have this problem.2,3 The main purpose of functional nasal surgery is to improve This study included 40 young adult patients who nasal breathing function. For this reason, the underwent four different nasal surgeries and 10 nasal septum deformity should be corrected first. healthy volunteers as control group, at a time Septoplasty is an effective surgical treatment for period of nearly 12 months between May 2011 correction of septal deviation. For septonasal and May 2012. Main complaints of the patients deformities, septorhinoplasty is frequently were nasal obstruction. All patients were performed which aims to correct functional informed about the study and informed consent condition and external deformities of the nose. was obtained in each case before surgery. The internal nasal valves may contribute to half Ethics committee approval was obtained of total airway resistance and deformities of this from the Eskisehir Osmangazi University. area can cause important nasal obstruction.4 Inclusion criteria were as follows: at least 18 Several methods including spreader graft, batten years old, septal deviation consistent with nasal grafts and flare sutures are used to support nasal obstruction at least for 3 months, persistent valve area and to avoid nasal obstruction.5 symptoms after a 4-week trial of medical As nasal obstruction is subjective and management (nasal steroid, antihistaminic and/ difficult to evaluate by clinical examination and or oral decongestants). also this subjective feeling of nasal obstruction Exclusion criteria were as follows: sinonasal can be deceptive. There are 2 methods to malignancy, prior nasal surgery (such as evaluate results after functional nasal surgery: septoplasty, septorhinoplasty, endoscopic sinus objective and subjective measures. Surgical surgery, nasal valve surgery, turbinate surgery, achievement can hardly be assessed with etc.), sinonasal infections and inflammatory Downloaded from wjps.ir at 3:13 +0330 on Tuesday March 10th 2020 subjective measurements. That is why objective diseases, septal perforation, craniofacial syndrome, assessment of nasal function should be used. nasal trauma or fracture and adenoid hypertrophy. Nasal Obstruction Symptom Evaluation Scale Comprehensive preoperative anamnesis was (NOSE scale) is used as a subjective method. obtained from all patients. They underwent NOSE scale is a disease-specific quality of life routine ear nose throat physical examination. The instrument for use in nasal obstruction and it diagnosis was performed with anterior rhinoscopy was used in several studies.6 and 0° rigid endoscope. The presence of valve NOSE scale is a short, valid and reliable problem was evaluated by modified Cottle test and method and also seems as a valuable subjective endoscopic nasal examination. instrument for evaluating functional nasal Depending on the applied operation, patients surgery. Currently one of the most commonly were divided into four different groups, each of used objective methods is acoustic rhinometry which had ten patients. Group 1: patients with a (AR). AR is based on analysis of sound waves diagnosis of isolated septal deviation and so they reflected from the nasal cavity. It is a noninvasive, underwent septoplasty, Group 2: patients with a simple and quick technique. AR is used for the diagnosis of septal deviation with nasal valve evaluation of patients undergoing septoplasty or collapse and so they underwent septoplasty other nasal surgeries, and it can provide objective with spreader graft, Group 3: patients with a information for the surgeon. AR has been used diagnosis of septonasal deformities and so they in other nasal operations to determine surgical underwent septorinoplasty and Group 4: patients effects, such as in turbinoplasty7 and endoscopic with a diagnosis of septonasal deformities with sinus surgery.8 nasal valve collapse and so they underwent www.wjps.ir /Vol.5/No.3/September 2016 238 Nasal obstruction after nasal surgeries septorhinoplasty with spreader graft. For The patients were asked to complete NOSE spreader graft; the upper lateral cartilages were scale, 1 week before and 1 month after the carefully dissected from the septum of the operation. The NOSE scale was used to assess submucoperichondrial layer, and the connections disease specific quality of life and was scaled were separated. from 0 to 100, with higher scores meaning more Septal cartilage was harvested, leaving a severe nasal obstruction. Sum of the answers 10-mm L-shaped strut for nasal support. Two were multiplied by five to base the scale out of a rectangular strips of cartilage were removed possible score of a 100 for analysis. There are 5 from the septum for use as spreader grafts and questions in this scale. (i) Nose obstruction and placed symmetrically and bilaterally along the stuffiness, (ii) Nose obstruction, (iii) Trouble dorsal edge of the remaining septal cartilage breathing through my nose, (iv) Trouble sleeping (Figure 1). All patients underwent surgery by the and (v) Unable to get enough air through my same surgeon using general anesthesia. Internal nose during exercise or exertion (Table 1). nasal splint or nasal packing was inserted at the The physician was blinded to the patient’s end of the operation and removed 2 days after NOSE scores, before and after surgery. AR was surgery. There were no serious complications in performed 1 week before and 1 month after the postoperative period. the operation by the same physician and using SRE 2000 Rhinometer (RhinoMetrics, Lynge, Denmark). Nasal cavities were cleaned by suction and prepared for AR. Measurements were performed with the patient in the sitting position after applying nasal decongestant (xylometazolin 0.01%, utilized three puffs for each nasal cavity) in a relatively quiet room at normal temperature (22-25OC) and humidity (50-60%). Patients were asked to hold their breath during the measurement. After 30 minute waiting period, three measurements were performed for both nasal passages
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