xRead - Nasal Obstruction (September 2024) Full Articles

15314995, 2023, 12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.30684 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

consists of fi ve questions evaluating the severity of fi ve different symptoms related to nasal obstruction, rated on a 5- point Likert scale. The total score ranges between 0 and 100, and a higher score implies a more severe nasal obstruction. 17 The present study is a systematic review and meta analysis aiming to quantify the effectiveness of septoplasty with or without turbinate surgery according to NOSE questionnaire scores. The hypothesis was that septoplasty with or without turbinate surgery is able to clinically improve patient-reported nasal obstructive symptoms in the post-operative follow-up. METHODS This systematic review was reported according to the Pre ferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. 18 Institutional review board approval and informed consents were not required for this study, since all the reported data were obtained from the available pub lished literature. The review protocol was registered on PROS PERO database (CRD42022325219). ture search strategy: population (P), adults affected by NSD; intervention (I), septoplasty with or without turbinate surgery; comparator (C), none; outcome (O), change in NOSE scale score at 6 months (primary outcome), and at 3,12 months (secondary outcomes); study type (S), case series, cohort studies, and RCT. Studies were excluded if: (a) they were not in English, (b) they were not available in full text form, (c) they include pediatric patients, (d) they were subgroup analysis of patients from a larger study, (e) aesthetic rhinoplasty was also performed, (f) procedures other than septoplasty with or without turbinoplasty were performed, (g) reported insuf fi cient data or data were not extractable, (h) follow-up time <3 months, (i) outcomes were not evaluated using the NOSE scale, (l) the article type was a confer ence abstract, a review, a case report, a book chapter or a letter to the editor. No publication date was imposed, but articles had to be published in a peer-reviewed journal. Data source and Study Searching An electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library using relevant keywords, phrases and medical subject headings (MeSH) terms. The search strategy applied for PubMed/MEDLINE was: ( “ Health-Related Quality Of Life ” OR “ HRQOL ” OR “ quality of life ” OR “ lifestyle ” OR “ well being ” OR “ QOL ” OR “ NOSE score ” OR “ NOSE questionnaire ” OR “ nasal obstruction symptom evaluation ” ) AND ( “ nasal septal deviation ” OR “ septum deviation ” OR “ septoplasty ” OR “ septal surgery ” OR “ functional nasal surgery ” OR “ nasal obstruction surgery ” ). The reference list of each selected articles was checked to screen for additionally potentially relevant studies (i.e., snowballing method). The last search was carried out on March, 2nd 2022. Eligibility Criteria The PICOS framework 19 was used in developing the litera

Library) were merged and the duplicates removed using the ref erence management software EndNote ® X9 (version X9.3.3). Titles and abstracts of unresolved papers were screened. When ever appropriate, full texts of relevant articles underwent subse quent evaluation for eligibility. In the presence of eventual discrepancies, a third reviewer (A.C.) was consulted to solve the conundrum. Data extracted from selected papers were archived in a cus tomized Excel ® (Microsoft Corp, Seattle, Washington, USA) spreadsheet with forced choice entry criteria. Risk of Bias and Study Quality Assessment Methodological quality of included studies was assessed independently by two separate authors (M.A.B. and F.C.). Meth odological Index for Non-randomized Studies (MINORS) criteria, 20 a validated instrument designed to assess the method ological quality of nonrandomized studies, were used to measure bias. A funnel plot was created using the effect size for NOSE scale score reduction at 6 months follow-up to examine a poten tial publication bias. Data Synthesis and Statistical Analysis Clinical measures were reported as provided by the individ ual studies. A single-arm meta-analysis of proportions was per formed to synthetize dichotomous variables using arcsine transformation of the data, while continuous variables were syn thetized through a meta-analysis of means using the generic inverse variance method. All data are reported with the corresponding 95% con fi dence intervals (CIs). A single-arm meta-analysis of means was used to calculate pooled NOSE score at baseline, while change in NOSE score after surgery was assessed with the mean difference (MD) between baseline and postoperative results after 3, 6, and 12 months. Raw effect size data were pooled using the “ metacont ” function in R software comparing between group mean differences. The MD and their 95% con fi dence intervals (CIs) were calculated for each study, and the pooled MD was measured for 3, 6, and 12 moths follow-up. Inverse variance method 21 was used to calculate the pooled effect estimate. Restricted maximum-likelihood estimator 22 was used to estimate the between-study variance ( τ 2 ). For the random effects model, Knapp-Hartung 23 adjustments were used to adjust test statistics and con fi dence intervals. Results are presented as pooled esti mates with 95% con fi dence intervals (CIs). A forest-plot graph was created for each outcome. Cochran ’ s Qmethod 24 was used to assess between studies heterogeneity, and I 2 was calculated as a measure of heterogene ity. 25 The I 2 value represents the percentage of total variation across studies caused by heterogeneity rather than by chance. Using a fi xed effects model, we assumed that all studies came from a common population and that the effect size is not signi fi cantly different among the different studies. If the heterogeneity test produced a low probability value (Q-statistic, p <0.05), meta-analysis was performed using a random effects model assuming both within-study and between-study variability for a more conservative estimate. In fl uence analysis 26 was performed to identify potential in fl uential studies. In particular, a leave one-out meta-analysis was performed to test the in fl uence of each included study on the overall effect and I 2 heterogeneity. More over, a subgroup analysis was performed to explore potential sources of heterogeneity for the primary outcome (e.g. level of evidence, MINORS score, septoplasty with or without inferior turbinate surgery). Scatter plots (Baujat plot) 27 were created for the 6 months follow-up. The horizontal axis ( x -axis) shows the

Data Extraction Two reviewers independently conducted the electronic liter ature search (M.A.B. and R.C.). The reference lists from three databases (i.e., PubMed/MEDLINE, Embase, and Cochrane

Laryngoscope 133: December 2023

Alessandri-Bonetti et al.: NOSE Score After Septoplasty

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