Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty.
OBJECTIVE
Patients with a septal deviation and concerns about nasal obstruction often undergo septoplasty to improve nasal airflow. Following primary septoplasty, however, some patients have persistent symptoms due to nasal valve dysfunction and may require nasal valve surgery.


OBJECTIVE
To evaluate the change in disease-specific quality of life for patients who undergo nasal valve correction after failed septoplasty using the Nasal Obstruction Symptom Evaluation (NOSE) survey and to determine whether identifiable anatomical risk factors are more common in patients with a history of failed septoplasty.


METHODS
Prospective observational outcomes study conducted at a tertiary care medical center. Forty patients who underwent nasal valve correction through an open approach from January 1, 2012, through December 31, 2014, with a history of septoplasty for nasal obstruction were included. Data analysis was conducted from January 1, 2013, through May 1, 2015. [corrected].


METHODS
Demographic information, a standardized nasal examination, and preoperative and postoperative NOSE scores were collected and reviewed.


METHODS
Comparison between preoperative and postoperative NOSE scores at 2, 4, and more than 6 months after surgery.


RESULTS
Forty patients were included in the study; 23 (57%) were male and 17 (43%) were female. The mean age was 39.3 years. Findings from preoperative nasal examination demonstrated moderate or severe internal nasal valve narrowing in 38 (95%) patients, internal nasal valve collapse in 19 (48%), external nasal valve narrowing in 18 (45%), or external nasal valve collapse in 16 (40%). The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 (95%) patients, dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). The mean (SD) preoperative NOSE score was 75.7 (20.1). Mean (SD) postoperative NOSE scores at 2, 4, and greater than 6 months were 31.4 (27.2), 34.0 (19.8), and 22.1 (18.8), respectively, with significantly improved NOSE scores at each time point compared with before surgery (P < .001).


CONCLUSIONS
Nasal valve dysfunction remains an underdiagnosed entity and should be considered in all patients with septal deviation before septoplasty, especially in patients with a severe dorsal deflection and a narrow middle vault. In this study, surgical nasal valve correction demonstrated a significant reduction in nasal obstruction, as measured by a validated outcome measure, in patients for whom a previous septoplasty had failed.


METHODS
4.
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Kyle J
KJ
Chambers
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Kate A
KA
Horstkotte
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Kerry
K
Shanley
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Robin W
RW
Lindsay
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome