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Objective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty. Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater‐effects‐adjusted latent surgical skill. We validated this model against conventional measures including the level of expertise and post‐graduation year (PGY) commensurate with the trainee's performance, the actual PGY of the trainee, and whether the surgical goals were achieved. Results: Our dataset included 188 assessments by 7 raters and 41 trainees. The model with one latent construct for surgical skill and the rater as a random effect was the best. Rubric scores depended on how severe or lenient the rater was, sometimes almost as much as they depended on trainee skill. Rater‐adjusted latent skill scores increased with attending‐estimated skill levels and PGY of trainees, increased with the actual PGY, and appeared constant over different levels of achievement of surgical goals. Conclusion: Our work provides a method to obtain rater effect adjusted surgical skill assessments in the operating room using structured rating scales. Our method allows for the creation of standardized (i.e., rater‐effects‐adjusted) quantitative surgical skill benchmarks using national‐level databases on trainee assessments. Level of Evidence: N/A Laryngoscope, 134:3548–3554, 2024 [ABSTRACT FROM AUTHOR]

Background: Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long‐term efficacy of septoplasty is unclear, and no literature reviews have examined long‐term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long‐term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. Data Sources: PubMed, EMBASE, Cochrane CENTRAL. Methods: A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. Results: After screening, 35 studies with 4,432 patients were included. Mean weighted post‐operative follow‐up time was 29.1 months (range 12–120 months). All studies reported significant improvement in subjective and objective outcomes at long‐term follow‐up compared to baseline. When comparing short‐term (<12 months) to long‐term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. Conclusions: Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long‐term follow‐up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. Level of Evidence: N/A Laryngoscope, 134:2525–2537, 2024 [ABSTRACT FROM AUTHOR]

Background: The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flap's axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width. Methods: Ten fresh latex‐injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally. Results: From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1–1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm. Conclusions: Based on the non‐vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0–2.3 cm. Level of Evidence: NA Laryngoscope, 134:2100–2104, 2024 [ABSTRACT FROM AUTHOR]

Objective: Septoplasty is the most frequently performed ENT surgery to correct nasal septal deviation (NSD). The present study aimed to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores, with the hypothesis that it is able to clinically improve patient‐reported nasal obstructive symptoms in the post‐operative follow‐up. Methods: An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results. Results: A total of 2577 patients (males: 65.1%, 95% CI: 59.9–70.2) with a mean age of 33.3 years (n = 1456, 95% CI: 30.4–36.2) were included in this meta‐analysis. The pooled baseline NOSE mean score was 68.1 (n = 2577, 95% CI: 64.3–71.9). The pooled MD in NOSE score at 6‐months follow‐up compared to baseline was −48.8 (n = 1730, 95% CI: −54.6 to −42.9). Conclusions: Functional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score. Level of Evidence: NA Laryngoscope, 133:3237–3246, 2023 [ABSTRACT FROM AUTHOR]

Objective: A deviated nasal septum (DNS) can result in an anatomical obstruction and impact lung function through prolonged suboptimal inspiration. Given the improvements in respiration reported by patients following septoplasty or septorhinoplasty (with or without inferior turbinate reduction), our study investigated the effect of these procedures on pulmonary function through a systematic review and meta‐analysis. Data Sources: Medline, Embase, Cochrane Databases, Web of Science, and Google Scholar. Review Methods: The review was registered with PROSPERO [CRD42022316309]. The study population was composed of adult patients (18–65) who were symptomatic with confirmed DNS. Extracted outcomes (pre‐operative versus postoperative) included the six‐minute walk test (6MWT) and pulmonary function tests (FEV1, FVC, FEV1/FVC, FEF25‐75, PEF). Meta‐analyses were performed using a random‐effects model. Results: Three studies included measures of the 6MWT in meters and all three found a statistically significant increase in the distance walked after surgery with a mean difference of 62.40 m (95% CI 24.79–100.00). Statistically significant improvements in PFT outcomes were observed with a standard mean difference of 0.72 for FEV1 (95% CI 0.31–1.13), 0.63 for FVC (95% CI 0.26–1.00), and 0.64 for PEF (95% CI 0.47–0.82). Of the twelve studies which measured PFT outcomes, six showed statistically significant improvements, three studies showed mixed results, and three studies found no difference in PFT outcomes between pre‐and post‐surgery testing. Conclusions: The present study suggests that pulmonary function does improve after nasal surgery for DNS, but the high heterogeneity observed in the meta‐analyses indicates that the evidence supporting this conclusion is low. Laryngoscope, 133:2837–2845, 2023 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: High anterior septal deviation (HASD) is an underreported anatomic variant that can affect the decision to perform septoplasty for access during sinus surgery and ease of postoperative debridement. This study aims to 1) describe an objective method of assessing HASD, and 2) explore its prevalence and implications for performing septoplasty. Study Design: Retrospective cross‐sectional study. Methods: Computed tomography scans from 2014 to 2020 were retrospectively reviewed. Two independent observers measured the following with respect to midline: distance to septum (SDD), distance to lateral nasal wall (LNW), and septal deviation angle (SDA). Results: A total of 147 patients were included, with excellent interrater reliability across 99 patients (0.8–0.9). Mean measurements across all patients were SDD (2.77 mm ± 1.34), SDD/LNW (0.26 ± 0.12), and SDA (8.9° ± 4.0). Of 102 patients who underwent sinus surgery, 47 received septoplasty. Compared to the non‐septoplasty cohort, the septoplasty cohort had a greater mean SDD (3.61 mm ± 1.48 vs. 2.27 mm ± 0.95; d = 1.10 [95% CI 0.67–1.51]), SDD/LNW (0.34 ± 0.13 vs. 0.21 ± 0.09; d = 1.18 [95% CI 0.76–1.60]), and SDA (11.1° ± 4.3 vs. 7.3° ± 3.4; d = 1.00 [95% CI 0.58–1.40]). Receiver operating characteristic cutoffs were SDD ≥2.43 mm, SDD/LNW ≥0.25, and SDA ≥7.6°, corresponding to a 49%–58% prevalence of HASD. Conclusion: HASD is relatively common and the methods described herein can reliably assess its dimensions. Measurements of SDD, SDD/LNW, and SDA exceeding cutoffs determined by this study may represent clinically significant deflections prompting consideration of septoplasty. These methods may aid in preoperative planning. Level of Evidence: 4 Laryngoscope, 132:1166–1171, 2022 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: To investigate the risk of nasal septal abscess (NSA) in patients with type 2 diabetes mellitus (T2DM) after septoplasty. Study Design: Retrospective cohort study through Taiwan National Health Insurance database. Methods: The Taiwan National Health Insurance Research Database was used to conduct this retrospective cohort study. A total of 382 patients with T2DM (DM group) diagnosed between 2000 and 2010 and 382 matched patients without a DM diagnosis (non‐DM group) were enrolled. Patients were followed up until death or December 31, 2013. NSA incidence was the main outcome. Results: After septoplasty, the cumulative incidence of NSA in the DM group was significantly higher than that in the non‐DM group (P <.001). Cox proportional hazards regression indicated a significant association between T2DM and higher NSA incidence (adjusted hazard ratio, 2.62; 95% CI, 1.44–3.61; P <.001). However, subgroup analysis and sensitivity testing demonstrated that the effect of T2DM on NSA risk was stable. In addition, the subgroup with a Diabetes Complications Severity Index (DCSI) of ≥1 had higher NSA risk than that with DCSI = 0 (adjusted hazard ratio, 3.58; 95% CI, 2.10–6.09; P <.001). The treatment type for NSA did not differ between the groups. Conclusions: T2DM is an independent risk factor for NSA in patients undergoing nasal septoplasty, and the NSA risk is greater among patients with high DM severity. Level of Evidence: IV Laryngoscope, 131:E2420–E2425, 2021 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. Study Design: Prospective cohort study. Methods: A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow‐up visits. All subjects were instructed to restart CPAP on the first postoperative night. Results: A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P <.05). By the third postoperative visit, average 22‐item Sino‐Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea–hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. Conclusions: Both quality‐of‐life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well‐tolerated when restarted the day after a septoplasty/turbinectomy or FESS. Level of Evidence: 4 Laryngoscope, 131:E1013–E1018, 2021 [ABSTRACT FROM AUTHOR]

Background: A bioabsorbable nasal valve implant (NVI) was introduced in 2016 as a minimally invasive solution to nasal valve collapse. Historically the introduction of less invasive procedures performable in‐office has resulted in an increase in volume. Our objective is to evaluate this trend as it relates to nasal vestibular repair, and its impact on healthcare utilization. Methods: We interrogated the Medicare Part B national database for nasal vestibular repair (CPT code: 30465), Unlisted nasal procedure (30999) and septoplasty (30520) from 2010 to 2017. Septoplasty was used as a surrogate for overall nasal procedural rate. Linear regression modeling was used to examine the changes in reported vestibular repair rate adjusting for septoplasty rate. Results: In the Medicare population, the rate of septoplasty was stable from 2010 to 2017, increasing from 26,962 to 30,194 at an annual rate of 1.5%. Coding for unlisted nasal procedure increased from 272 to 333 at an adjusted annual rate of 1.1% over this time period. Coding for nasal vestibular repair increased from 2026 to 5331 over this interval at an adjusted annual rate of 0.9% from 2010 to 2016 but significantly increased to 5% between 2016 to 2017 (P <.0001). Conclusion: The reported volume of nasal vestibular repair increased significantly in the year following Food and Drug Administration approval of NVIs. In the absence of a corresponding increase in septoplasty, this temporal relationship suggests that the introduction of NVIs impacted the utilization of this procedural code. Level of Evidence: N/A Laryngoscope, 2020 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To assess and define the level of pain after rhinoplasty and septoplasty and to better define the strength and quantity of postoperative opioids needed.Study Design: Prospective outcomes research.Methods: Two groups of patients were enrolled. One group underwent septoplasty with/without turbinate reduction and the other group underwent functional and/or cosmetic rhinoplasty (with/without septoplasty). Patients completed a 15-day log (daily, beginning on the day of surgery) to record the analgesics used and the daily maximal level of pain using a visual analog scale. Level of pain, number of days of moderate or severe pain, total number of opioid pills used, and total morphine milligram equivalents (MMEs) of opioid used were assessed.Results: Pain after septoplasty and rhinoplasty was generally mild. Average pain was moderate through postoperative day (POD) 2 after rhinoplasty and only on POD 0 after septoplasty. There was no statistically significant difference between the two groups in terms of number of opioid tablets consumed or total MMEs used. Patients undergoing rhinoplasty consumed more acetaminophen than septoplasty-only patients (7471 ± 1009 vs. 2781 ± 585, P = .0112). Ninety percent of patients would have received adequate analgesia with as few as 11 opioid tablets. All patients had excess opioid at the end of the study period.Conclusions: Both septoplasty and rhinoplasty are associated with mostly mild pain, and postoperative opioid requirements are quite low. Surgeons can reliably reduce opioid prescription after septoplasty and rhinoplasty to as few as 11 tablets. Reducing opioid prescribing will not adversely affect the patient but will reduce the availability of opioids for misuse or diversion.Level Of Evidence: 2c Laryngoscope, 129:2020-2025, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Responsible prescribing of postoperative pain medications is necessary in combatting the current opioid epidemic in the United States. The goal of this study was to determine which clinical factors affect opioid usage following functional endoscopic sinus surgery (FESS).Study Design: Retrospective medical records study.Methods: This is a single-institution retrospective study of subjects undergoing FESS by the senior author between September 2016 and December 2017. Opioid usage was assessed for each patient at the first postoperative visit. Univariate and multivariable analyses were performed to investigate factors associated with pain medication usage. Patients using opioids prior to surgery were excluded.Results: A total of 136 patients were stratified into three groups based on number of opioid tablets taken during the first week after surgery: 31 patients (23%) took no opioids, 61 patients (45%) took one to five tablets, and 44 patients (32%) took more than five tablets. Gender, extent of surgery, revision surgery, polyp status, and cystic fibrosis did not significantly vary between the three groups. Multinomial logistic regression analysis with backward stepwise variable selection method revealed that those who had septoplasty (odds ratio [OR]: 4.84, 95% confidence interval [CI]: 1.68-13.98; P < .01) or were of younger age (OR 0.96, 95% CI: 0.93-0.99; P = .01) had significantly higher odds of taking >5 tablets.Conclusions: The majority of patients undergoing FESS did not take more than 5 opioid tablets after surgery. Concurrent septoplasty and younger age were associated with increased opioid usage. Knowledge of such factors can help surgeons to assess opioid prescribing patterns and to counsel their patients on postoperative pain. Laryngoscope, 129:1751-1755, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine outcomes of patients with displaced nasal bone fractures after closed nasal reduction (CNR).Study Design: Retrospective patient review.Methods: Review of all patients presenting to the emergency department of a tertiary-care, level 1 trauma hospital with a nasal bone fracture over a 2-year period, followed by telephone survey after CNR.Results: Six hundred seven patients presented to the emergency department in 2015 and 2016 with a diagnosis of nasal bone fracture. Of these, 134 patients met inclusion criteria and underwent CNR without septal reduction. Those with sports-related injuries and those with a septal fracture identified on computed tomography imaging were significantly more likely to undergo CNR. Ninety-one patients completed the post-CNR telephone survey. Over 90% of patients were satisfied with the procedure. However, patients with septal fractures reported worse outcomes, as 53.6% versus 24.1% (P = .0025) disagreed that CNR improved nasal breathing. Of all patients, 11 (2%) eventually underwent septorhinoplasty, with the presence of septal fracture on imaging a significant risk factor.Conclusions: Nasal bone fractures are a common injury, often managed initially with CNR. Patients with septal fractures should be counseled on the high risk of posttraumatic nasal deformity and obstruction despite CNR. In addition, addressing a septal fracture found on imaging may be warranted with either closed septal reduction or early aggressive management given the poorer outcomes seen in the present study. Although these patients are more likely to have definitive treatment, many forego later intervention despite persistent symptoms, emphasizing the need for early intervention or close follow-up.Level Of Evidence: 3 Laryngoscope, 129:1784-1790, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty.Study Design: Evidence-based systematic review.Methods: PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included.Results: Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution.Conclusions: Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations.Level Of Evidence: NA Laryngoscope, 129:E200-E212, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method.Methods: We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze.Results: Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively.Conclusions: Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia.Level Of Evidence: 1B Laryngoscope, 127:1026-1031, 2017. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Septal deviation and hypertrophic inferior turbinates are a frequent cause of nasal breathing disorders. The goal of this study was to prove the effectiveness and safety of three current turbinoplasty techniques.Study Design: This is a prospective, three-arm, single-blinded, single-center, randomized controlled trial.Methods: Sixty patients were randomly assigned to either anterior turbinoplasty (ATP) (n = 20), radiofrequency ablation (RFA) (n = 19; Celon Pro Breath), or novel submucous radial diode laser ablation (DLA) (n = 21; ELVeS Radial PainLess, wavelength = 1,470 nm), each in combination with standard septoplasty. Acoustic rhinometry, rhinomanometry, subjective nose questionnaire, and saccharin test served as outcome parameters for preoperative and 3-month, 1-year, and 2-year postoperative examinations.Results: After 3 months 47/60 patients were evaluated, 28/60 patients were evaluated after 1 year, and 26/60 patients were evaluated in the 2-year follow-up visit. An improvement of nasal breathing was observed in all three groups in all follow-up visits. The increase of endonasal volume 2 (volume between the nasal valve and body of the inferior turbinate) was statistically significant in the ATP and RFA group after 3 months and 2 years, and in the RFA group also after 1 year. The DLA group failed to reach significance level in all follow-up visits. Subjective evaluation of nasal breathing improved in all three groups.Conclusions: In this trial, three different current techniques of turbinate surgery in combination with standard septoplasty were effective for the improvement of nasal breathing. The ATP and RFA techniques were more effective in the long term than DLA.Level Of Evidence: 1b. Laryngoscope, 2016 127:303-308, 2017. [ABSTRACT FROM AUTHOR]

Our objective was to measure short- and long-term outcomes of children presenting with recalcitrant idiopathic epistaxis. The study was an 11-year (2000-2011) retrospective chart review of children evaluated and treated for epistaxis. A retrospective review of patients with diagnostic International Classification of Diseases, Ninth Revision code 784.7 (epistaxis) and 21.5/21.88 (septoplasty) was completed reviewing age at presentation, type of surgery, and number of bleeding events prior to and after surgery. In our cohort, almost 100% of children with idiopathic recurrent epistaxis responded to topical treatments. About 0.2% were refractory (20/9239), and 90% of those (18/20) resolved with either a traditional septoplasty (14/20) or modified septoplasty (6/20) without cartilage excision, with a mean follow-up of 35 months. One of the patients who did not show resolution was found to have Von Willebrand disease, which likely contributed to this outcome. Septoplasty surgery, with or without cartilage removal, appears beneficial for refractory idiopathic epistaxis in children.Level Of Evidence: 4 Laryngoscope, 126:2833-2837, 2016. [ABSTRACT FROM AUTHOR]

Objectives: Gabapentin and pregabalin has been shown to reduce postoperative pain effectively. In this meta-analysis, we aimed to assess the role of preoperative gabapentinoids for attenuating postoperative pain after nasal surgery in patients via a meta-analysis of the literature.Data Sources: PubMed, Scopus, and Cochrane Database.Methods: Literature was screened from inception to December 2015. Nine articles to compare the preoperative administered gabapentinoid (gabapentinoids groups) with a placebo or analgesics (control group) were included for analysis of the outcomes of interest, which included postoperative pain scores, analgesic intakes, or side effects, such as sedation, nausea and vomiting, blurred vision, operative bleeding, dizziness, and headache, during a 24-hour postoperative period.Results: The pain score reported by the physician and need for analgesics during the first 24 hours, postoperatively, in the gabapentinoids group significantly reduced compared with the control. Additionally, the gabapentinoids had no significant effect on the incidences of side effects except blurred vision compared with the control during the 24 hours postoperatively. In the subgroup analyses of these results according to operation type, these subgroups showed similar effects on reducing postoperative pain and adverse effects.Conclusions: Preoperative gabapentinoids could attenuate postoperative pain without significant adverse effects in patients who undergo nasal surgery. However, blurred vision may be a handicap that requires consideration for use and education for patients. Further clinical trials will be of help in supporting the results of this study.Level Of Evidence: NA Laryngoscope, 126:2232-2241, 2016. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Third-party payors have begun to demand imaging studies to document septal deviation prior to authorizing septoplasties. This study aims to determine whether septal deviation findings on computed tomography (CT) correlate with symptoms of nasal obstruction as determined by the Nasal Obstruction Symptom Evaluation (NOSE) scale.Study Design: Prospective and retrospective chart review.Methods: Patients 18 years or older undergoing CT scans, which included the nasal septum, were asked to complete a NOSE scale survey and report the laterality of any possible obstruction. Coronal CT images of subjects were graded by two blinded otolaryngologists and two blinded neuroradiologists using a grading system devised by the authors.Results: Seventy-three subjects met inclusion/exclusion criteria. Interobserver reliability about the degree of septal deviation on CT scans was moderately good to substantial (κ values, 0.43 to 0.72). There was poor correlation between NOSE scores and degree of deviation on CT scans (Kendall's τ, 0.031 to 0.045; P values all >.05). There was poor concordance between the side of symptoms that patients reported and the side that observers thought was most deviated on CT.Conclusions: There is little correlation between septal deviation findings on CT scans and symptoms of nasal obstruction. The results do not support a role for CT scans as either a clinically meaningful or necessary test to investigate uncomplicated nasal obstruction.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine whether septoplasty when combined with ambulatory oropharyngeal surgery increases postoperative complications.Study Design: Cross-sectional analysis of multistate ambulatory surgery and hospital databases.Methods: Ambulatory adult septoplasty and oropharyngeal surgical procedures (tonsillectomy and uvulopalatoplasty [UPPP]) were extracted from the state ambulatory surgery databases for New York, Florida, Iowa, and California for 2010-2011. Cases with concurrent sinus surgery were excluded. Cases were linked to the state emergency department databases and the state inpatient databases to identify revisits within 14 days. The rates of unplanned revisits and postoperative bleeding were determined and compared among groups undergoing solely oropharyngeal surgery versus groups undergoing oropharyngeal surgery combined with septoplasty.Results: Among 26,280 tonsillectomies alone versus 1,002 tonsillectomies + septoplasty, rates for unplanned revisits and hemorrhage were 13.2% and 12.8% (P = .66) and 4.9% and 7.0% (P = .003), respectively. Among 2,598 UPPPs alone versus 1,343 UPPPs + septoplasty, rates for revisits and hemorrhage were 11.4% versus 10.1% (P = .242) and 3.5% versus 3.8% (P = 0.683), respectively. Among 389 UPPP/tonsillectomies versus 164 UPPP/tonsillectomies + septoplasty, rates for revisits and hemorrhage were 11.8% versus 8.5% (P = .256) and 3.9% versus 6.1% (P = .247), respectively. Among all cases and groups, there were mortalities only in the UPPP alone group.Conclusions: The addition of septoplasty to oropharyngeal ambulatory surgical procedures does not significantly increase the rate of unplanned revisits or postoperative hemorrhage except in the case of septoplasty added to tonsillectomy, with a small percentage increase in hemorrhage rate. Combining septoplasty with ambulatory oropharyngeal surgery is clinically reasonable in adults.Level Of Evidence: 2b. [ABSTRACT FROM AUTHOR]

Objective Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross-sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction. Study Design Prospective randomized study. Methods The study was conducted on two groups (51 patients) with symptoms and signs of nasal obstruction associated with septal body and inferior turbinate hypertrophy that were refractory to medical therapy. In the turbinoplasty only (ITR) group (n = 25), conventional turbinoplasty was only performed on the inferior turbinate. In the septal body reduction (SBR) group (n = 26), concurrent bilateral microdebrider-assisted SBVR was performed during the turbinate surgery. Results The nasal symptoms, including nasal obstruction, rhinorrhea, itching, and sneezing, had significantly improved at 3 months after treatment in both groups ( P < 0.001). Improvement of nasal obstruction in the SBR group was greater than that in the ITR group at 3 months ( P < 0.05). Acoustic rhinometry demonstrated a significant increase in the cross-sectional area and nasal volume in both groups 3 months after surgery. The postoperative change in nasal volume was higher in the SBR group ( P < 0.05). No adverse reactions such as bleeding, infection, adhesions, or olfactory changes were encountered in the SBR group. Conclusions Combined SBVR and turbinoplasty appears to be more effective than turbinoplasty alone for the treatment of nasal obstruction in patients with inferior turbinate and septal body hypertrophy. Level of Evidence 1b. Laryngoscope, 125:1523-1528, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Determine rates and reasons for revisits after adult ambulatory sinonasal surgery. Study Design Cross-sectional analysis of multi-state ambulatory surgery and hospital databases. Methods Ambulatory adult sinonasal procedures were extracted from the State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010. Cases were linked to the State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring 0 to 14 days after the procedure. The number of revisits (including readmissions) was determined as well as the reason for revisit. The overall rate of and intervention rate for postprocedural bleeding were determined. Results A total of 35,678 ambulatory sinonasal cases were extracted (mean age, 47.5 years). Overall, 5.0% of patients had a revisit after surgery (18.9% revisited the ambulatory surgery center, 67.0% the emergency department, and 14.1% to inpatient admission). The primary diagnoses at the first revisit were bleeding (23.0%), acute pain (3.7%), and fever/dehydration (3.8%). Overall, 0.8% of patients incurred a second revisit. Among all cases, 1.2% and 0.3% presented with a bleeding diagnosis at a first and second revisit, respectively. Among revisits, 1.0% and 17.9% underwent a procedure to control bleeding at the first and second revisits, respectively. Three deaths were noted for an overall 14-day mortality rate of 0.0084%. Conclusion There is a nonnegligible revisit rate after ambulatory sinonasal surgery. The most common reasons for revisit include bleeding, but also acute pain and fever/dehydration. These particular complications should be targeted for prevention to reduce postoperative revisit rates. Level of Evidence 2b. Laryngoscope, 124:1983-1987, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Caudal septal deviation interrupts normal nasal breathing, due to the narrowing of the external valve area and nasal valve angle. In this study, we found a different approach for correction of caudal septal deviation with no associated deformity of the external nose. Study Design: Individual case-control study. Methods: The 39 patients completed questionnaires by interviews postoperatively for assessment of nasal obstruction. In addition, patients assessed the severity of their nasal symptoms (i.e., mouth breathing, mouth dryness, hyposmia, rhinorrhea, epistaxis, snoring, postnasal drip, and headache) preoperatively and postoperatively using a visual analog scale (VAS). Improvement in the treatment of nasal obstruction using a VAS and a questionnaire for subjective satisfaction were evaluated 3 months after septoplasty. To evaluate outcomes objectively, endoscopic photographs of the nasal cavity and acoustic rhinometry before and after surgery were evaluated. For comparison between preoperative and postoperative status, the Wilcoxon signed ranks test was used. Results: Patients reported a significant decrease in the VAS severity of all nasal symptoms. The minimal cross-sectional area (MCA1) of the convex side after vascular constriction using acoustic rhinometry showed significant widening. Patients were divided into a turbinoplasty group and a nonturbinoplasty group, and the turbinoplasty group showed a significant increase in both the convex side and concave side in MCA1 and in the convex side in the anterior portion of the inferior turbinate. Conclusions: Endonasal septoplasty using bony batten grafting for caudal septal deviation resulted in an improvement of nasal obstruction symptoms and acoustic rhinometry components. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: This experimental study in a rabbit model aimed to investigate the use of glass ionomer cement as a tissue adhesive on the dorsal L- strut. Study Design: Sixteen adult male New Zealand White rabbits were used. The rabbits were equally divided into two groups as the control and the study groups. Methods: The nasal septum was exposed through a superior approach. A graft was harvested preserving an L-strut cartilage. In the control group, a vertical incision was performed on the dorsal part of the L-strut to divide it into two cut ends, and the graft was sutured to the cut ends with 5-0 polydioxanone suture. In the study group, the reconstruction of the dorsal L-strut was made by fixing the graft to the cut ends with glass ionomer cement as the tissue adhesive. At 2 months, the rabbits were sacrificed. The nasal septum was removed for histopathological examination. Results: No foreign body giant cells or acute inflammation were determined in the rabbits. The study group had less pronounced chronic inflammation. Comparison of the groups revealed that parameters regarding vascularization, cartilage proliferation, and new cartilage cells were statistically significant different between the two groups (P5.010, P5.010, P5.028, respectively). More vascularization, cartilage proliferation, and new cartilage cells were seen in the study group. Conclusions: Glass ionomer cement was effective for the reconstruction of the dorsal L-strut without any foreign body reaction, cartilage necrosis, or marked inflammation in rabbits, and it may be a potentially beneficial alternative to suture fixation. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis 1) Study outcomes of revision septoplasty using a validated disease-specific questionnaire and a patient satisfaction survey; 2) assess the effect of surgery on the use of medication to treat nasal congestion; and 3) report on sites of persistent septal deviation identified at revision septoplasty. Study Design Prospective, single-center outcome study of patients with symptomatic nasal obstruction and persisting septal deviation despite prior septal surgery. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered preoperatively and at 3 and 6 months following revision surgery. Patients were also questioned regarding ease of breathing and medication use preoperatively and postoperatively, as well as satisfaction with the surgical outcome. Anatomic site(s) of residual septal deviation were recorded intraoperatively. Results Thirty-nine patients completed the study. Mean NOSE scores decreased significantly from 75.9 preoperatively to 14.9 3 months after revision surgery. Mean Ease-of-Breathing scores over this interval improved from 3/10 preoperatively to 8.5/10. Both results were sustained at 6 months ( P <0.0001). Patient satisfaction was very high, and many patients required less medication to treat symptoms of nasal congestion postoperatively. Deviations persisting from prior surgery most commonly involved the dorsal or caudal septum. Conclusion In patients who experience ongoing nasal obstruction with a persistent septal deviation despite prior septoplasty, revision surgery significantly improves disease-specific quality of life, results in high patient satisfaction, and may diminish the need for nasal medications postoperatively. Caudal or dorsal deflections may be more difficult to correct, leading to the need for revision surgery. Level of Evidence 2C Laryngoscope, 124:1290-1295, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the relationship between subjective symptoms of nasal obstruction and the corresponding nasal anatomical parameters using paranasal computed tomography (PNS CT). Study Design Retrospective chart review at a tertiary referral center. Methods We studied 277 patients who underwent evaluation by the Nasal Obstruction Symptom Evaluation scale and a visual analogue scale of nasal obstruction for preoperative evaluation; 197 patients with nasal obstruction who underwent septoplasty were enrolled in the study group, and 80 patients without nasal septal deviation and without nasal obstruction who underwent a trans-sphenoidal pituitary tumor operation were enrolled in the control group. A preoperative coronal CT image was used to calculate both nasal cavity cross-sectional areas and the septal deviation angle at the three levels (internal nasal valve, ostiomeatal unit [OMU], and choana). Results Differences between the study group and the control group were found in all nasal anatomical parameters at the internal nasal valve, OMU, and choana. In the study group, subjective nasal obstruction symptoms were correlated with the septal deviation angle and the nasal cavity cross-sectional area at the OMU and the choana levels. However, there was no correlation between subjective symptoms of nasal obstruction and anatomical factors at the nasal valve level ( P < .05). Conclusions Coronal PNS CT revealed a relationship between subjective nasal obstructive symptoms and anatomical factors at the middle and posterior nasal levels, especially in patients complaining of stuffy nose. When septoplasty is performed, we must pay attention to correction of middle and posterior nasal septal deviation. Level of Evidence 3. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The purpose of this article is to assess the relative rates of septal hematomas, synechiae, and septal perforations associated with methods commonly used to manage the nasal septum after septoplasty. As a secondary objective, we assessed the relative contribution of each method of septal management with respect to pain and patient discomfort. Study Design Systematic review. Methods A systematic literature search was performed for all relevant English randomized controlled, cohort, or case-control trials. Inclusion criteria included any study that assessed postoperative septal hematoma, perforation, or synechiae formation and reported on these outcomes regardless of method of septoplasty. Two authors independently extracted study information and analyzed all included articles for bias. Results A total of 279 studies were identified, with 17 meeting the inclusion criteria. The majority of the studies had a high risk of bias that prevented the performance of a meta-analysis. Eight studies provided data on postoperative pain associated with different techniques, and quilting sutures were found to be significantly less painful than both nasal packing and septal splints. Conclusions Due to the low level of evidence and the high bias of the studies, the results of this systematic review fail to demonstrate a clear benefit among any of the postseptoplasty treatment techniques. However, the results do demonstrate that septal sutures are associated with less postoperative pain versus the other methods of septal management in this review. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Septoplasty is a frequently performed surgical procedure with the most common indication being nasal airway obstruction. Almost universally, health insurance companies mandate a trial of medical therapy consisting of intranasal corticosteroids prior to performance of septoplasty regardless of clinical assessment. Evidence for this requirement is lacking. We sought to evaluate the initial clinical assessment as a predictor of response to this mandated trial of medical treatment. Study Design: Retrospective review of prospectively collected data on 137 consecutive patients who presented with symptoms of nasal obstruction and a deviated nasal septum on physical examination. Methods: Patients were placed into one of three cohorts based on prediction of 1) failure of medical therapy with subsequent septoplasty, 2) success of medical therapy without subsequent septoplasty, or 3) unable to make a prediction. Patients from each cohort were assessed for subsequent response to medical therapy and ultimate need for septoplasty. Results: Overall clinical assessment had a sensitivity of 86.9%, specificity of 91.8%, positive predictive value of 93.6%, and negative predictive value of 96.4% for detecting/predicting need for septoplasty. The accuracy of the overall clinical assessment is considerably better than severe deviation at any one septal anatomical site. Of patients whose response to medical therapy could not be predicted, 61.3% failed medical therapy and needed surgery; this is statistically equivalent to a 50/50 distribution between either needing septoplasty or not. Conclusions: Clinical assessment at initial presentation of patients with nasal obstruction and deviated septum is highly accurate in predicting which patients will need septoplasty. Laryngoscope, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: During septoplasty, otherwise normal cartilage and bone are removed and routinely submitted for pathologic examination. According to the College of American Pathologists, however, the examination of bone and cartilage from septoplasty and rhinoplasty may be left to the pathologist's discretion. We explored the processing of tissues removed during septoplasty, examining the clinical value and implications of current practices. Study Design: Retrospective chart review. Methods: Our database was searched for septoplasty (CPT code 30520) procedures performed specifically for the indication of nasal obstruction. Results: Five hundred sixteen consecutive cases from 15 surgeons spanning a 2-year period were identified. In the majority of cases, septal tissues removed during surgery were submitted to pathology. The majority of cases (>90%) involved septoplasty performed in conjunction with another procedure, most commonly addressing the inferior turbinates. All septal specimens received gross examination by a pathologist, and a smaller fraction were also examined histologically. Gross findings included the qualitative appearance of the specimen and dimensional measurements of bone and cartilage fragments. No abnormalities were identified (by gross or histologic examination) in any of the specimens. Associated costs included specimen handling, storage, and pathology fees. Conclusions: In our health care system, it is common practice to submit tissues removed during septoplasty for pathologic examination. This study demonstrates that routine evaluation of septal tissues following surgery for obstruction has no clinical value whatsoever, and is associated with direct and indirect costs. Given the current health care climate, this practice should be further scrutinized and reconsidered. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Recent guidelines from the American Society of Anesthesiologists recommended postoperative monitoring for most patients undergoing surgery for obstructive sleep apnea (OSA). These guidelines, however, are largely based on retrospective literature and expert opinion. The appropriate level of postoperative monitoring remains controversial. Our objective was to prospectively document the early postoperative course of patients undergoing OSA surgery. Study Design: Prospective cohort study. Methods: One hundred twenty-one patients (age 43.9 ± 13.5 years, 79.8% male) with sleep-study proven OSA (apnea-hypopnea index 31.9 ± 22.7) who were undergoing surgery for OSA at our tertiary care center were recruited from 2007 to 2009. Outcome measures were: 1) incidence of respiratory complications requiring nursing intervention, 2) level of postoperative blood oxygen saturation divided into three groups: mean oxygen saturation in recovery room (SpO2recovery), mean oxygen saturation in step-up unit (SpO2step-up), and lowest oxygen saturation over the 24 hour period (SpO2minimum). These results were then compared to the benchmark literature. Results: The overall incidence of nursing intervention in response to a respiratory complication (3.4%) was significantly less than expected (P < .002). Mean SpO2recovery was 92.9 ± 3.2%, SpO2step-up was 95.9 ± 1.6%, and SpO2minimum was 92.8 ± 3.1%. No variables were identified as being predictive of any of the outcome measures. Conclusions: The incidence of respiratory events requiring intervention in the early postoperative course of OSA patients was low (3.4%). Routine postoperative inpatient monitoring may not be required in many cases. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Determine the prevalence of ambulatory sinonasal surgical procedures and perioperative outcomes in the United States. Methods: The National Survey of Ambulatory Surgery 2006 release was examined, extracting all cases of nasal or sinus surgery. Sinonasal surgical procedures were grouped according to septoplasty and/or turbinate surgery, sinus surgery, facial plastic surgery, and other procedures. Overall and group population-based sinonasal procedure prevalences were estimated from the sample. Frequency of general anesthesia, discharge status, and unexpected emergency room visit estimates were obtained. Perioperative complication rates for cardiac arrest, malignant hyperthermia, postoperative emesis, and blood transfusion were determined as well. Results: Overall, an estimated 600,000 patients underwent ambulatory sinonasal procedures in 2006 with a mean age of 40.4 years and 53.7% male predominance. On a per patient basis, there were 260,000 septoplasties, 257,000 sinus cases, 134,000 plastics cases, and 103,000 other cases. Facial plastics procedures were less likely to use general anesthesia (72.8%) than the overall cohort (90.7%, P < .001). The vast majority of patients were discharged to home with an unexpected admission rate of 2.65%. Among the sample, there were no cases of cardiac arrest, malignant hyperthermia, or blood transfusion. The postprocedure emesis rate was 1.3%, not significantly different among procedure groups ( P = .692). Only 0.1% of patients visited the emergency room postprocedure. Conclusions: Approximately 600,000 ambulatory sinonasal cases are performed each year in the United States. Complication rates and unexpected postprocedure mission rates are quite low indicating the safety and effectiveness of the ambulatory setting for sinonasal surgery. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Septoplasty in the prepubertal age group is a controversial operation because of concerns regarding retardation of subsequent midfacial growth. This study uses a validated rabbit snout model to determine if septoplasty results in midfacial growth retardation, and if the retardation can be averted by replacing resected cartilage with a porous polyethylene implant. Study Design: Prospective controlled animal study. Methods: Sixteen 9-week-old New Zealand white rabbits were divided into four groups: two control and two experimental. The experimental groups both underwent conservative submucoperichondrial surgical excision of a portion of their septum, leaving a generous dorsal and caudal septal strut for nasal support similar to what would be done clinically in humans. One of the experimental groups had replacement of the resected area by a rigid porous polyethylene graft, and in the other experimental group the resected area was left empty. Cephalometric measurements were performed on radiographs taken at the time of implantation, and at sacrifice when the rabbits were mature at 24 weeks of age. Results: There were significant disturbances in snout growth between experimental and control groups, and no significant differences between the two experimental groups or between the two control groups. Conclusions: These data demonstrate midfacial growth retardation after conservative septoplasty in young rabbits, and that this retardation could not be averted by replacing the resected cartilage with a porous polyethylene graft. These data are in agreement with human studies. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objective: A deviated nose with involvement of a severely deviated cartilaginous dorsum is a particular challenge for rhinoplasty surgeons. We applied a new approach for treating such cases, the 'dorsal L-strut cutting and suture technique,' and assessed its efficacy and the surgical outcomes. Study Design: Retrospective chart review. Methodss: The study population consisted of 27 patients who received the 'cutting and suture technique of dorsal L-strut' to control a severe cartilaginous dorsal deflection between February 2004 and September 2006. Two otolaryngologists who were not involved in surgeries assessed surgical outcomes. Preoperative and postoperative photographs were studied to evaluate outcomes, and anthropometric measurements were made. Postoperative complications were assessed. Results: Postoperative assessments showed that 81.5% of patients had 'excellent' or 'good' deviation correction. Two (7.4%) patients experienced cephalic rotation of the tips and shortening of the nasal length. There were no reports of recurrence, saddling, or infection during follow-up. Pre- and postoperative anthropometric measurements showed there was no significant change in tip projection, nasal length, nasofrontal angle, or nasolabial angle. Conclusions: The dorsal L-strut cutting and suture technique appears to be a useful method for correcting severe cephalocaudal convexity of the dorsal L-strut in deviated noses. [ABSTRACT FROM AUTHOR]

Objectives: To identify patterns of failure of the L-strut, to identify elements of the nasal framework that support the L-strut, and to investigate the effect of altering L-strut design on its stability. Study Design: Laboratory study with human cadaveric heads and computational modeling. Methods: Directional forces were applied to cadaveric L-struts and patterns of failure with incremental force were noted. Computational modeling using the finite element method (FEM) was employed to determine quantitatively the effect of various modifications on the stability of the L-strut. Results: The L-strut was found to respond to frontal force initially by buckling. This buckling was reversible until the force exceeded a certain threshold when the L-strut broke at the bony-cartilaginous junction. The threshold force varied depending on the length of the overlap with the bony vault. Intact mucoperichondrium provided significant stability. Modeling with FEM showed that the preservation of a triangular piece of cartilage at the dorsal anchor of a narrowed L-strut can offset some of the loss in mechanical stability. Conclusions: Intrinsic elasticity of the septal cartilage, the mucoperichondrial flap, and overlap with the bony vault all contribute to the stability of the L-strut, which is enhanced by preserving a small segment of cartilage at the bony-cartilaginous junction of the dorsal L-strut. [ABSTRACT FROM AUTHOR]

Background: The symptoms and treatments for nasal obstruction are numerous and common. Yet, a consensus on a surgical approach or, even more importantly, how to define the success of any approach is lacking in the literature. A disease-specific outcomes instrument recently developed by the American Academy of Otolaryngology, known as the Nasal Obstruction Symptom Evaluation (NOSE) scale, has allowed for a validated, uniform method to compare different treatments for nasal obstruction. Methods: Using the NOSE scale, we prospectively compared the use of bilateral radiofrequency inferior turbinate reduction (BRITR) only with that of BRITR with septoplasty in the treatment of nasal obstruction caused by the combination of septal deviation and turbinate hypertrophy. NOSE scores were obtained pretreatment and at 3 month and 6 month follow-up. Results: Our data demonstrated significant improvement from baseline after 6 months for the NOSE scores in both the BRITR ( P < .001) and BRITR/septoplasty groups ( P = .023). No statistical difference was noted in the amount of postoperative improvement between the two treatment groups ( P = .304). Both groups did demonstrate a large, clinically important effect using a distribution-based assessment of clinical change. Despite equal clinically effective results, estimated costs for each treatment option differed significantly, with the office-based BRITR only group providing significant cost savings compared with the hospital-based BRITR/septoplasty group. Conclusions: This study suggests that BRITR should be considered as an initial treatment option for nasal obstruction rather than a septoplasty with turbinate reduction in patients with the clinical findings of both a septal deviation and turbinate hypertrophy after failure of medical therapy. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis A graduated protocol involving closed reduction, septoplasty, osteotomies, upper lateral cartilage release, anterior perpendicular plate fracture, and camouflaging cartilage grafts yields a higher percentage of straight noses in cases of acute fracture than treatment with closed reduction alone. Study Design Retrospective chart and literature review followed by a prospective, non-randomized sequential trial. Methods Closed reduction was performed on 26 cases of acute nasal fracture and the results were compared with a subsequent series of 79 cases treated using a more complete protocol. Results The cases treated with the more complete protocol yielded straighter noses. The difference was statistically significant using Wilcoxon rank sum analysis at the P = .028 level. Conclusions Treatment of the acutely fractured nose involving an individually tailored protocol of closed reduction, septoplasty, osteotomies, release of the upper lateral cartilages, fracture of the anterior extension of the perpendicular plate of the ethmoid, and camouflaging cartilage grafts yields straighter noses than treatment by closed reduction alone. [ABSTRACT FROM AUTHOR]

Objective To measure the dimensions, composition, and possible structural and/or histopathological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum. Study Design A prospective, nonrandomized, and morphometric study. Methods Nineteen patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity underwent surgery for correction of nasal obstruction. Patients' specimens were compared with those of a control group consisting of 10 inferior turbinates removed at autopsy. Quantitative measurements of the inferior turbinate histological sections were carried out and included the width of the layers and morphometric calculations of the relative proportions of the soft tissue constituents. Also, qualitative study was performed to detect pathological changes. Results Of all layers, the inferior turbinate bone underwent a twofold increase in thickness and manifested the most significant expansion ( P ≤.001), whereas the contribution of the mucosal layers to the inferior turbinate hypertrophy was modest. The morphometric analysis revealed a larger proportion of venous sinusoids in hypertrophic turbinates, but the difference was small and statistically insignificant. Qualitative assessment disclosed normal mucosal architecture in all inferior turbinates with compensatory hypertrophy. Eleven remained intact, while eight disclosed mild to moderate pathological changes. Conclusions The data gathered in the present study are of importance to the decision-making process regarding turbinate surgery. The significant bone expansion and the relative minor role played by the mucosal hypertrophy would support the decision to excise the inferior turbinate bone at the time of septoplasty. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Nasal continuous positive airway pressure (CPAP) is the standard therapy for sleep apnea; however, compliance rates are historically poor. Among the most commonly cited reasons for nonadherence is nasal obstruction. Our study sought to examine if nasal surgery actually increases CPAP compliance. Study Design Prospective case series. Methods Nasal CPAP-intolerant obstructive sleep apnea (OSA) patients, with documented nasal obstruction, underwent septoplasty plus inferior turbinoplasty. Preoperative and postoperative data were collected on CPAP usage per night and subjective nasal obstruction with the Nasal Obstruction Symptom Evaluation (NOSE) Scale questionnaire. Results Eighteen patients met inclusion criteria and underwent septoplasty. CPAP usage increased significantly from 0.5 hours per night preoperatively to 5 hours per night postoperatively ( P < .05). Subjective nasal obstruction on the NOSE Scale decreased from 16.1 preoperatively to 5.4 following surgical intervention ( P < .05). CPAP pressure decreased from 11.9 preoperatively to 9.2 after surgery, with a trend toward signifiance ( P = .062). Conclusions This study demonstrates improved CPAP compliance rates following septoplasty in OSA patients with nasal obstruction. Correction of nasal obstruction should be offered in nasal CPAP-intolerant individuals to improve CPAP compliance. Level of Evidence 3b Laryngoscope, 124:317-319, 2014 [ABSTRACT FROM AUTHOR]