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Ef fi cacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta-analysis

Mario Alessandri-Bonetti, MD; Andrea Costantino, MD ; Giuseppe Cottone, MD; Riccardo Carbonaro, MD; Federica Cardone, MD; Francesco Amendola, MD; Armando De Virgilio, MD, PhD ; Enrico Robotti, MD; Paolo Persichetti, MD; Luca Vaienti, MD

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 out come was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between base line 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. KeyWords: nasal obstruction, NOSE, quality of life, septal deviation, septoplasty. Level of Evidence: NA Laryngoscope , 133:3237 – 3246, 2023

obstruction 5 with a negative impact in patients ’ quality of life (QOL) and mood. 6 – 8 In this context, nasal septal devi ation (NSD) is one of the most prevalent upper airway diseases causing airway obstruction, 9 – 11 with some authors reporting prevalence up to 70% – 80% in the gen eral population. 6,12 NSD impairs the air fl ow and prevents from breathing comfortably through the nose. As a conse quence, it can cause crusting and bleeding, mucosal dam age, compensatory turbinate hypertrophy, and altered olfactory function. 13 Septoplasty is the most frequently performed ENT surgery to correct NSD in adults. 14 However, debate has grown regarding the poor existing evidence about the ef fi cacy of septoplasty in the treatment of NSD-related obstructive symptoms, and a need for randomized con trolled trials (RCT), and high level of evidence studies has been voiced in recent years. 15,16 A previous system atic review conducted in 2017 tried to de fi ne the effective ness of septoplasty in improving nasal obstruction due to NSD. 6 However, a proper meta-analysis was not per formed, and the authors concluded that literature evi dence did not support fi rm conclusions on its effectiveness. One of the most used instruments in evaluating patient-reported obstructive symptoms is the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. The NOSE questionnaire was developed in 2004 by Stew art et al, and it was the fi rst validated, disease-speci fi c QOL instrument to measure nasal obstruction. 17 It

INTRODUCTION Nasal airway obstruction is de fi ned as the subjective sensation of insuf fi cient air fl ow or impaired breathing through the nose. 1 Nasal obstruction is amongst the most common complaints in the general population, and it is frequently encountered by various specialists including otolaryngologists, facial plastic surgeons, and allergists. 2,3 Symptoms of nasal obstruction are subjective and can therefore be misleading. Moreover, the fi ndings of nasal examination and endoscopic evaluation may not always correlate with the patient complaints. 4 In fact, minimal nasal pathologies can cause a feeling of serious nasal From the Department of Reconstructive and Aesthetic Plastic Surgery, I.R.C.C.S. Istituto Galeazzi ( M . A .- B ., G . C ., R . C ., F . C ., F . A ., L . V .), University of Milan, Via Riccardo Galeazzi 4, 20161, Milan, Italy; Department of Biomedical Sciences ( A . C ., A . D . V .), Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele – Milan, Italy; Otorhinolaryngology Unit ( A . C ., A . D . V .), IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano – Milan, Italy; Private Practice ( E . R .), Clinica Sant ’ Apollonia, Via Giovanni Motta, 37 – 24123, Bergamo, Italy; and the Department of Reconstructive and Aesthetic Plastic Surgery ( P . P .), Campus Bio-Medico University of Rome, Via Alvaro Del Portillo, 200, Rome, Italy. Editor ’ s Note: This Manuscript was accepted for publication on March 21, 2023. The authors have no other funding, fi nancial relationships, or con fl icts of interest to disclose. Send correspondence to Andrea Costantino, MD, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele – Milan, Italy. Email: andrea.costantino94@gmail.com

DOI: 10.1002/lary.30684

Laryngoscope 133: December 2023

Alessandri-Bonetti et al.: NOSE Score After Septoplasty 3237