Can Upper Airway Surgeries Improve Lower Airway Function ? A Prospective Study

Abstract

Deviated nasal septum and turbinate hypertrophy are the most common causes for nasal obstruction, which compromise nasal airflow and increases airway resistance. These conditions can further reduce the airflow to lung, which will affect the lung volume and function subsequently reduces the exercise tolerance. The present study aimed to evaluate the impact of upper airway surgeries like septoplasty and turbinoplasty on lower airway functions using simple tests like spirometry and 6 min walking test (6mWt). This research was a prospective study. There were 88 subjects in the study who completed follow up. Spirometry and 6mWt was performed 1 day before and 1 month after surgery in all subjects. Mean preoperative and postoperative values of spirometry (forced vital capacity (FVC),forced expiratory volume in 1 s (FEV1), forced expiratory volume in 1 s/ forced vital capacity (FEV1/FVC), peak expiratory flow rate (PEFR) and 6mWt (systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation) parameters were compared and analyzed. Percentage of improvement of each parameter was compared with the type of surgery, side of obstruction, age of the patient and duration of symptom. Spirometry showed statistically significant improvement in all 4 parameters after surgery in 86 subjects. 6mWt showed statistically significant improvement in SBP and SpO2 and there was no significant improvement in DBP and HR. We also observed that improvement in parameters was irrespective of age and duration of symptoms. So this study concludes that airway narrowing nasal diseases can compromise lower airway function.

The Effects of Nasal Surgery on Pulmonary Function: A Systematic Review and Meta‐Analysis

“…A DNS primarily results in a physical obstruction and thus impacts lung function through prolonged periods of sub-optimal inspiration. 28 Nasal obstruction results in mouth breathing, negating the nose's warming and humifying process and subsequently changing pulmonary surfactant viscosity, causing bronchial constriction. 28,47 The primary outcome of this review was PFT (spirometry) changes.…”

“…28 Nasal obstruction results in mouth breathing, negating the nose's warming and humifying process and subsequently changing pulmonary surfactant viscosity, causing bronchial constriction. 28,47 The primary outcome of this review was PFT (spirometry) changes. Despite the relative ease and low risk of spirometry testing, pre-post PFT evaluation is not routinely conducted in patients undergoing nasal surgery as it does not alter the clinical course of treatment and begets added costs to the healthcare system.…”

“…Unlike the example of rhinitis with concomitant asthma, studying the impact of a DNS on pulmonary function is more anatomical than cellular and immunological. A DNS primarily results in a physical obstruction and thus impacts lung function through prolonged periods of sub‐optimal inspiration 28 . Nasal obstruction results in mouth breathing, negating the nose's warming and humifying process and subsequently changing pulmonary surfactant viscosity, causing bronchial constriction 28,47 …”

“…Characteristics and outcome summaries of the 13 studies are presented in Table I. 2,[26][27][28][29][30][31][32][33][34][35][36][37] The included studies were published between 2010 and 2021. Geographically, most of the studies were from Turkey (6/13, 46%) and India (5/13, 38%), with the remaining two from Egypt (2/13, 15%) (Table I).…”

“…Geographically, most of the studies were from Turkey (6/13, 46%) and India (5/13, 38%), with the remaining two from Egypt (2/13, 15%) (Table I). The majority of included studies (9/13, 69%) were from journals indexed in reputable databases (PubMed, EMBASE, SCOPUS, Web of Science), 2,26,28,30,[32][33][34]37 the remaining (4/13, 31%) were found in Google Scholar. 27,29,31,35,36 All included articles followed an interventional pre-poststudy design.…”