title: Clinical assessment is an accurate predictor of which patients will need septoplasty.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA. ahmad_sedaghat@meei.harvard.edu
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.forename: Nicolas Y
authors.initials: NY
authors.lastname: Busaba
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cunningham
authors.forename: David A
authors.initials: DA
authors.lastname: Kieff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000002:abnormalities / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult