Newswise — The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by mucous membrane that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.
A "deviated septum" occurs when the septum is shifted away from the midline. The most common symptom from a deviated or crooked septum is difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections.
Septoplasty is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma. The conditions that call for this surgery include nasal airway obstruction, persistent nosebleeds, and nasal septal deformity in the presence of other intranasal surgery or problems, such as recurrent infections.
But how effective is septoplasty in relieving nasal obstruction? It has been difficult to determine because there was limited evidence of effectiveness of septoplasty for nasal obstruction, and there were no validated instrument for the disorder, and prior studies were often retrospective, used non-validated questionnaires, or included sinus and other associated procedures.. To fill this need, the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) initiated the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. This research effort sought to: (1) Develop a validated outcomes instrument for use in nasal obstruction; (2) Determine whether nasal septoplasty improves patients' disease-related quality of life as measured by the new instrument; (3) Assess impact of other clinical factors on outcome.
Organizers of the NOSE Study were AAO-HNS members Michael G. Stewart MD MPH, Timothy L. Smith, MD MPH, Edward M. Weaver MD MHS, and Bevan Yueh MD MPH, and Jonas T. Johnson MD, as well as David L. Witsell, MD MHS, Maureen T. Hannley PhD, and Tanya R. Darrow, all three with the National Center for the Promotion of Research in Otolaryngology. The NOSE Study results will be presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation http://www.entnet.org Annual Meeting and OTO EXPO, being held September 21-24, 2003, at the Orange County Convention Center, Orlando, FL.
In this study a criterion was applied to the hypothesis that septoplasty by an otolaryngologist (ear, nose, and throat specialist) in adults with nasal obstruction due to septal deviation improves the disease-specific quality of life, measured three months after the procedure has been completed.
Methodology: The NOSE Study was a prospective, observational, outcomes-based study of patients undergoing septoplasty for nasal obstruction. Patients excluded from the surgery were those whose septoplasty was part of endoscopic sinus surgery, sleep apnea surgery, or a rhinoplasty. Those included in the study had to be older than 18 years, been diagnosed with a septal deformity and symptom of nasal obstruction for greater than three months, and had undergone a four week trial of medical management, with persistent symptoms
Essential to this research effort was a new outcomes instrument, the Nasal Obstruction Symptom Evaluation (NOSE) Scale. {This questionnaire was found to have a Test-retest reliability of 0.702 and an internal consistency reliability of 0.785. The NOSE scale was tested and validated in a group of patients, and found to be reliable, valid, and sensitive." )
Enrollment in the prospective study entailed 149 patients screened with 62 enrolled; 59 completed. The three month follow-up consisted of 81 percent of test subjects; the six month follow-up involved a included 65 percent of the patients.
Results: The 5-question NOSE scale has a range of scores from 0 (no problem) to 100 is based on a scale of 100 (worst quality of life) with a declining score indicating significant approval improvement in disease-specific quality of life. Accordingly, the test subjects' average scores registered the following after the septoplasty:
"¢ Three months month change: 67.5 baseline " 23.1 post-surgical (p<0.0001)"¢ Six month change: 67.5 baseline " 26.6 post-surgical (p<0.0001)"¢ The statistical difference in the score of three versus six months was not significant.
The change score represented an average change in quality of life of two or more categories, e.g. from "fairly bad problems" to "very mild problem" . Other factors that were considered but were not found significant was the patients' indicating that they had nasal allergies, were smokers, or other key demographic information.
Conclusions: The study found that the septoplasty procedure for nasal obstruction due to septal deviation improves the disease-specific quality of life, measured three months after the procedure has been completed.
RSS