Patient-reported outcome measures are widely used among surgical specialties to estimate the impact of interventions on patients' health-related quality of life. There is a wide variety of elective operative procedures in otolaryngology, all of which aim to improve quality of life. As septal deviation has a prevalence up to 65%, we as doctors should use questionnaires to choose those patients with the greatest likelihood of improvement after septoplasty.
This research showed a statistically and clinically significant enhancement in quality of life and nasal obstruction scores after septal surgery. NOSE baseline scores for our patient population (67.5 ± 19.5) was similar to the study by Stewart et al.(9) (60.37 ± 20.38). NOSE scores after surgery(9) were also similar (26.6 ± 23.8 vs. 39.63 ± 33.22). We have demonstrated that NOSE scores are dependable on the results from other measures and so this self-report questionnaire can be used to assess the effectiveness of septoplasty..
There are controversies in the literature regarding potentially positive results of septoplasty with turbinoplasty vs. septoplasty alone. Both Stewart(9) and Uppal(11) found no statistically significant difference between either group. Nielsen et al.(25) compared three groups of patients: septoplasty, radiofrequency therapy of the inferior turbinate (RFIT), and both procedures. They concluded that patients who underwent RFIT with septoplasty complained less about postoperative nasal congestion than patients who went through RFIT only. We haven’t performed RFIT on our patients, just septoplasty.
In a systematic review of patient-reported nasal obstruction scores of the PubMed database,(20) normal and anomalous values of NOSE and VAS scores were settled for clinical use. This approach could be helpful in categorizing the severity of nasal obstruction, guiding treatment, educating patients, and measuring surgical outcomes.
Bugten et al.(26) revealed that nasal blockage may augment symptoms such as snoring, oral breathing, and nasal discharge, which may therefore weaken the general health of the patient. Surgery leads to a highly significant symptom improvement.
Furthermore, nasal septoplasty is often performed to some patients who have coexisting diseases such as chronic rhinosinusitis, obstructive sleep apnea, asthma, or allergy. These are all conditions which may be affected by nasal blockage. Patients who suffer for allergy might not achieve as good postoperative outcomes as non-allergic patients after surgery. This group should benefit from additional preoperative diagnostic procedures, such as computed tomography of nose and sinuses, to improve preoperative planning. Nevertheless, it is strongly recommended that allergic patients are also receive medical treatment postoperatively to optimize the results after surgery(26).
It was shown in the study by Thorstensen(27) that asthmatic patients have more symptoms of nasal blockage than non-asthmatic patients, and that they need an open nose to optimize airflow to the lower airways. A blocked nose, with consequent lack of humid, warm, and clean inspired air may harm the lungs and lead to worsening of asthma, so treatment of nasal blockage in asthmatics is particularly important(28).
Many patients with CRS do have a deviated nasal septum, but we excluded this group of patients from our study. The reason was so we could focus solely on nasal obstruction and its impact on quality of life.
This study has limitations. We have not randomized the patients to other treatment options for comparison. The major strength of this study is that it is prospective and from one otolaryngology hospital with more than 100 beds. All patients selected for surgery were asked to participate. From the findings of this study, we encourage other specialists to use the NOSE questionnaire: it can successfully guide treatment and can act as a clinically meaningful measure of surgical outcome.