Evidence and evidence gaps in therapies of nasal obstruction and rhinosinusitis

Rotter, Nicole

doi:10.3205/cto000133

Cited by 2 publications

(2 citation statements)

References 189 publications

(239 reference statements)

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“…The latter has increasing relevance in modern medicine as QOL assessment allows an individual estimation of therapy success. Additionally, evidence-based medicine plays an important role in rhinosurgery although the subjective benefit of surgical procedures is difficult to measure [ 12 ]. This needs high-quality studies to prove the effectiveness of surgical therapies.…”

Section: Discussionmentioning

confidence: 99%

Treatment success after rhinosurgery: an evaluation of subjective and objective parameters

Martín¹,

Hauck²,

Witzleben³

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Septal deviation and nose deformities are widely prevalent. As a consequence, patients may complain about difficulties in nasal breathing leading to a perception of diminished disease-specific quality of life. In a prospective randomized trial, we aimed to analyse the outcome of septoplasty (SPL) and septorhinoplasty (SRP) on patient satisfaction. Methods Patients with functional indication for SPL (n = 19) or SRP (n = 54) were included and randomized for additional turbinoplasty. Preoperative clinical symptoms were collected with SNOT-20 GAV (Sinu-nasal outcome test-20—German adapted version) and NOSE© (nasal obstruction symptom evaluation) questionnaires. The final evaluation of treatment success was performed 9 months after surgery with SNOT-20 GAV, NOSE© and a self-established feedback questionnaire. Nasal breathing and obstruction were objectively measured with rhinomanometry and acoustic rhinometry [minimum cross-sectional area 2 (MCA2)]. Results Minimum cross-sectional area 2 was statistically improved compared to the pre-treatment value in SPL (p = 0.0004) and SRP (p = 0.0001). Regarding MCA2 values of matched patient groups, similar findings were detected (SPL: p = 0.0013, SRP: p < 0.0001). Sinu-nasal outcome test-20 GAV and NOSE© scores were significantly reduced after both surgical procedures (NOSE©: SPL: p < 0.0001, SRP: p < 0.0001; SNOT-20 GAV: SPL: p = 0.0068, SRP: p < 0.0001). Evaluation of patient satisfaction in a self-established feedback questionnaire revealed a motivation of 81% of patients to redo the surgery (SPL 13/16, SRP 34/42) and a notably general satisfaction of 86% for SPL and 80% for SRP. Conclusion Rhinosurgery leads to quantitative better nasal breathing and increased disease-specific satisfaction. However, this study implies the importance of the right selection of patients and the correct indication of the surgical technique.

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Section: Discussionmentioning

confidence: 99%

Treatment success after rhinosurgery: an evaluation of subjective and objective parameters

Martín¹,

Hauck²,

Witzleben³

et al. 2021

Eur Arch Otorhinolaryngol

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“…COD has been associated with obstructive sleep apnea syndrome in a recent metanalysis, demonstrating a linear correlation at metaregression of pooled data included [ 6 ]. And COD has indirectly been attributed to specific causes based on questionnaire surveys and image examinations of the nasal cavity [ 7 , 8 ], there is limited evidence for the obstruction to air flow in patients with COD [ 9 ]. Viral infection could develop also smell impairment acting onsite-specific for the olfactory cell as SARS-CoV-2 disease, leading to a mild nasal inflammation through a transient neurotoxic effect [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of conductive olfactory dysfunction using computational fluid dynamics

et al. 2022

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Conductive olfactory dysfunction (COD) is caused by an obstruction in the nasal cavity and is characterized by changeable olfaction. COD can occur even when the olfactory cleft is anatomically normal, and therefore, the cause in these cases remains unclear. Herein, we used computational fluid dynamics to examine olfactory cleft airflow with a retrospective cohort study utilizing the cone beam computed tomography scan data of COD patients. By measuring nasal–nasopharynx pressure at maximum flow, we established a cut-off value at which nasal breathing can be differentiated from combined mouth breathing in COD patients. We found that increased nasal resistance led to mouth breathing and that the velocity and flow rate in the olfactory cleft at maximum flow were significantly reduced in COD patients with nasal breathing only compared to healthy olfactory subjects. In addition, we performed a detailed analysis of common morphological abnormalities associated with concha bullosa. Our study provides novel insights into the causes of COD, and therefore, it has important implications for surgical planning of COD, sleep apnea research, assessment of adenoid hyperplasia in children, and sports respiratory physiology.

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Evidence and evidence gaps in therapies of nasal obstruction and rhinosinusitis

Cited by 2 publications

References 189 publications

Treatment success after rhinosurgery: an evaluation of subjective and objective parameters

Treatment success after rhinosurgery: an evaluation of subjective and objective parameters

Analysis of conductive olfactory dysfunction using computational fluid dynamics

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