BACKGROUND INFORMATION:
Chronic nasal obstruction is a bothersome problem that is often treated surgically by the otolaryngologist after medical management fails to alleviate the patient's symptoms. While nasal obstruction can be attributed to many different etiologies, a complete history and physical examination provides information as to the specific cause, and how it might be best addressed. In many patients a deviated septum alone results in unilateral or bilateral nasal obstruction that has a fixed anatomic basis. Correcting this crooked nasal septum is thought to improve the ability of patients to breathe through their nose and ideally should address the patient's complaints. If the turbinates are enlarged, correcting the septum alone may not relieve all of the patient's complaints.

COG*ENT recently performed an analysis on data collected from 18 different centers on patients undergoing FESS for chronic rhinosinusitis. In this query, we looked to see if the outcome of those patients undergoing FESS alone was different from the outcome of those patients who had FESS plus a septoplasty or turbinate reduction for nasal obstruction. The outcomes instrument used in this study was The Chronic Sinusitis Survey. While all patients showed significant improvement at three months follow-up, those who had a concomitant septoplasty and/or turbinate reduction showed even greater improvement compared to the FESS alone patients (P<0.001).

The objectives of this study are 1) develop a disease-specific outcomes tool for nasal obstruction, and 2) use this instrument to examine the effectiveness of nasal septoplasty with or without turbinate reduction in relieving nasal obstruction with follow-up at three and six months after surgery.

We hypothesize that nasal septoplasty with or without turbinate reduction will have a large and significant benefit in reducing complaints associated with nasal obstruction.

PURPOSE OF STUDY:
This is a prospective cohort study designed to evaluate the effectiveness and disease-specific quality of life associated with surgical treatment of chronic nasal obstruction due to septal deviation in adult patients. Since many patients with septal deviation also have co-existing turbinate hypertrophy, the study will be stratified by recommendation for and surgical treatment of the inferior turbinates as an adjunct measure.

PUBLISHED OUTCOME OF STUDY:

Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study.

Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90.

We conducted a prospective observational outcomes multicenter study with 14 sites and 16 investigators, including private practice and academic settings. Patients had had septal deviation and symptomatic nasal obstruction for at least 3 months, and medical management had failed.

METHODS: Patients with septal deviation completed a validated outcomes instrument before and 3 and 6 months after septoplasty, with or without partial turbinectomy.

RESULTS: Fifty-nine patients underwent surgery; there was a significant improvement in mean NOSE score at 3 months after septoplasty (67.5 versus 23.1, P < 0.0001), and this improvement was unchanged at 6 months. Patient satisfaction was very high, and patients used significantly fewer nasal medications.

CONCLUSIONS: In patients with septal deformity, nasal septoplasty results in significant improvement in disease-specific quality of life, high patient satisfaction, and decreased medication use.