A prospective cohort study assessing the clinical utility of the Cottle maneuver in nasal septal surgery

Abstract

BackgroundA nasal septal deviation can have a significant detrimental effect on a patient’s quality of life. Nasal valve collapse (NVC) often co-exists with a septal deviation. The Cottle maneuver is one of the most common methods to diagnose NVC; however, no study has assessed the efficacy of this physical exam finding. This study tests the hypothesis that patients with nasal obstruction due to a septal deviation with a negative pre-operative Cottle maneuver will demonstrate a greater improvement in their Nasal Obstruction Symptom Evaluation (NOSE) score, compared to patients who demonstrate a positive pre-operative Cottle maneuver, when assessed at 12 months following a septoplasty with turbinate diathermy.MethodsThis was a prospective Cohort Study. The population was 141 patients with nasal obstruction due to a septal deviation with or without nasal valve collapse, excluding patients with bilateral complete nasal valve collapse. Patients were placed in cohorts according to the results of the Cottle maneuver (positive or negative). A NOSE questionnaire was administered at baseline and 12-months after a septoplasty with turbinate diathermy. Non-adjusted NOSE scores were used (score out of 20). An ANOVA was used to compare if there was a difference in outcomes between patient cohorts.ResultsOne hundred and forty-one patients completed 12-month follow-up with 71.5% of patients demonstrating a positive Cottle maneuver at baseline. The mean (95% C.I.) difference in NOSE score at 12 months between patients with a positive Cottle versus a negative Cottle was 0.18 (− 1.6 to 1.92; p = 0.38).ConclusionIn a univariate, single surgeon study, a positive Cottle Maneuver does not appear to influence outcomes in the described patient population compared to those with a negative Cottle Maneuver when undergoing a septoplasty.

Diagnosis and management of septal deviation and nasal valve collapse - a survey of Canadian otolaryngologists

“…Furthermore, false negatives can occur such as in the case of osteum internum fibrosis [15]. A recent study demonstrated no change in outcome in surgical success after a septoplasty in patients with either positive or negative Cottle Maneouver [16]. These results put into question the utility of the notion that patients with a positive Cottle Maneouver, when used as a single examination, truly benefit from anything more than a septoplasty.…”

“…Furthermore, as anatomy does not always correlate with obstruction for septal deviation and NVC, it may be important to determine novel outcome measures to assist in management [19]. The NOSE score is one outcome measure that may be used for this particular purpose [16]. In addition, it is unknown if certain tests are applicable to both types of collapse, and more studies are needed to evaluate methods to differentiate internal and external NVC.…”

European position paper on diagnostic tools in rhinology

“…the cheek skin lateral to the nasolabial fold is pulled laterally, increasing tension in the lateral nasal wall and thereby widening the nasal valve (15) . The result is positive if the patient reports improved breathing as a result of this.…”

Rinoplastía y rinoseptoplastía funcional: Mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales

“…Esta consiste en traccionar lateralmente la mejilla, lo que tensa la pared lateral nasal y abre la VNI. La prueba se considera positiva cuando el flujo aéreo inspiratorio por la fosa examinada mejora, lo que se observa en pacientes con válvulas estrechas o colapsadas 6 . Aunque muchas personas notarán cierto beneficio en el flujo nasal, en casos de colapso esta mejoría será sustancial.…”