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Functional Rhinoplasty Improves Quality of Life


SEATTLE -- Functional rhinoplasty improves the quality of life of patients with a severe nasal obstruction, according to surgical research here.

SEATTLE, Sept. 18 -- Functional rhinoplasty improves the quality of life of patients with a severe nasal obstruction, according to surgical research here.

In a prospective cohort study, 41 patients reported that surgery brought significant improvements over their pro-operative evaluation on the Nasal Obstruction Symptoms Evaluation (NOSE) scale, found Sam P. Most, M.D., of the University of Washington, who is now at Stanford.

The study shows that "functional rhinoplasty techniques are effective in improving nasal airway function as measured by a patient-based, disease-specific, quality-of-life instrument," Dr. Most reported in the September-October issue of Archives of Facial Plastic Surgery.

Obstruction of the nasal passages is commonly encountered by otolaryngologists and facial plastic surgeons, and causes include septal deviation, valve insufficiency, and turbinate hypertrophy, Dr. Most noted.

Some small studies have shown a benefit for functional rhinoplasty to correct such anatomical conditions, he said, and to expand on those results, he enrolled a larger number of patients who had severe nasal obstruction with an identifiable anatomical cause.

Patients were older than 18, refractory to medical management for at least a year, and has not had nasal trauma or surgery for at least a year, he reported. Mean follow-up overall was 227 days, although follow-up varied in length depending on which procedure was undertaken.

Before surgery, all by the same surgeon, patients were asked to complete the NOSE scale, which is scored from zero to 100, with higher scores indicating worse function, and to mark on a linear scale how bad they thought their nasal obstruction was.

The study found:

  • For all patients, the mean baseline NOSE score was 58.4 out of 100, and the mean linear score was 7.6 out of 10.
  • After surgery, the mean NOSE score was 15.7 and the mean linear score was 2.2.
  • Both changes were statistically significant at P<0.01.

The NOSE scale has five components, and most patients experienced significant improvements on all of them, the study showed. They are nasal congestion, nasal blockage, trouble breathing through the nose, trouble sleeping, and difficulty getting enough air through the nose during exercise.

The exceptions, Dr. Moss reported, were the five patients who had a septoplasty with turbinate reduction. They reported significant improvements in nasal stuffiness or blockage but non-significant improvements in ability to breathe through the nose, trouble sleeping, and ability to get enough air through the nose during exercise.

The study's strengths are its prospective design, its use of a validated instrument to measure quality of life, and its patient-based outcome assessment, Dr. Moss said.

Also "because I performed all of the surgical procedures, inter-surgeon technique variability was minimized," he said.

On the other hand, he said, patient numbers were small and the study was performed at a tertiary medical facility, which may have drawn patients with more severe nasal obstruction than what is generally seen in the community.

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