Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review

Egmond, M.M.H.T. van; Rovers, Maroeska M.; Tillema, Alice; Heerbeek, Niels van

doi:10.4193/rhin18.016

Cited by 57 publications

(75 citation statements)

References 29 publications

(69 reference statements)

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“…Treatment may consist of septoplasty or non‐surgical management. As the rationale behind septoplasty is to reduce symptoms of nasal obstruction rather than merely straightening the deviated septum, non‐surgical management is an equally suited alternative under current conditions of equipoise, which was confirmed by a recent systematic review . Surgical and non‐surgical management share the same target population (adults with nasal obstruction and a deviated septum) and intended effect (relieve of nasal complaints), and are considered suitable comparators …”

Section: Methodsmentioning

confidence: 90%

“…Septoplasty, that is surgical correction of the deviated nasal septum, is an illustrative example within ENT‐practice. Although septoplasty is a common treatment for nasal obstruction, current literature on its effectiveness is scarce and inconclusive . The estimated prevalence of a deviated septum ranges up to 80%, whereas only a minority suffers from nasal obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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Objective The objective of this study was to demonstrate how decision‐analytic modelling can help to determine circumstances under which surgery may become cost‐effective, using septoplasty as an example. Design We developed a decision‐analytic model comparing septoplasty to non‐surgical management for nasal obstruction in adults with a deviated septum. Based on the estimated cost difference between both treatments, we calculated the minimal (a) gain in quality‐adjusted life‐years, or (b) reduction in productivity losses needed for septoplasty to be cost‐effective. Input was derived from literature and publicly available data sources. The time horizon of our model was one year, and the willingness‐to‐pay per quality‐adjusted life‐year was €20 000, in accordance with current guidelines. Results The cost difference between septoplasty and non‐surgical management for nasal obstruction due to a deviated nasal septum was €2227 per patient from a healthcare perspective (including direct healthcare costs) and €3288 per patient from an extended perspective (additionally including travel expenses and productivity losses due to poor health). In comparison with non‐surgical management, septoplasty needed to gain 0.11 to 0.16 QALYs or save 13 sick days for nasal obstruction. The longer septoplasty's effect lasts, the more time it will have to compensate its extra costs. Conclusion This study shows that the known cost difference between treatments can be used as the starting point to determine beneficial effects needed for cost‐effectiveness of surgical interventions. The effect required by septoplasty from a healthcare perspective seems potentially achievable, meaning that it would be useful to perform an RCT assessing the actual benefits of septoplasty.

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Section: Methodsmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Egmond¹,

Rongen²,

Hedeman³

et al. 2018

Clinical Otolaryngology

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“…The effectiveness of septoplasty with or without turbinate surgery remains unclear and there is a lack of high-quality evidence of its benefit in the literature [10,11]. Not all patients improve with surgery.…”

mentioning

confidence: 99%

“…Where septoplasty fails and further surgery becomes necessary, revision rates are reported to be high [14]. There is also a lack of robust evidence about the additional benefit of turbinate surgery [11]. One study showed reduced revision rates for septoplasty when the turbinate tissue is reduced [15]; other studies report no added long-term benefit from turbinate reduction [16][17][18].…”

mentioning

confidence: 99%

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Nasal Airway Obstruction Study (NAIROS): a phase III, open-label, mixed-methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction

Rennie

O’Hara

Rousseau

et al. 2020

Trials

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Background: Septoplasty (surgery to straighten a deviation in the nasal septum) is a frequently performed operation worldwide, with approximately 250,000 performed annually in the US and 22,000 in the UK. Most septoplasties aim to improve diurnal and nocturnal nasal obstruction. The evidence base for septoplasty clinical effectiveness is hitherto very limited.Aims: To establish, and inform guidance for, the best management strategy for individuals with nasal obstruction associated with a deviated septum. Methods/design: A multicentre, mixed-methods, open label, randomised controlled trial of septoplasty versus medical management for adults with a deviated septum and a reduced nasal airway. Eligible patients will have septal deflection visible at nasendoscopy and a nasal symptom score ≥ 30 on the NOSE questionnaire. Surgical treatment comprises septoplasty with or without reduction of the inferior nasal turbinate on the anatomically wider side of the nose. Medical management comprises a nasal saline spray followed by a fluorinated steroid spray daily for six months. The recruitment target is 378 patients, recruited from up to 17 sites across Scotland, England and Wales. Randomisation will be on a 1:1 basis, stratified by gender and severity (NOSE score). Participants will be followed up for 12 months post randomisation. The primary outcome measure is the total SNOT-22 score at 6 months. Clinical and economic outcomes will be modelled against baseline severity (NOSE scale) to inform clinical decision-making. The study includes a recruitment enhancement process, and an economic evaluation.

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Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta‐analysis

et al. 2023

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ObjectiveSeptoplasty 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.MethodsAn electronic search was performed on PubMed/MEDLINE, Embase, and Cochrane Library. The primary outcome was the change in NOSE score at 6 months after surgery. It was assessed with the mean difference (MD) between baseline and postoperative results.ResultsA 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).ConclusionsFunctional septoplasty with or without turbinate surgery shows a critical improvement of obstructive symptoms and quality of life according to the validated NOSE score.Level of EvidenceNA Laryngoscope, 2023

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Septoplasty for nasal obstruction due to a deviated nasal septum in adults: a systematic review

Abstract: Despite the routine application of septoplasty in clinical practice, the current body of evidence does not support firm conclusions on its effectiveness.

Cited by 57 publications

References 29 publications

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness

Nasal Airway Obstruction Study (NAIROS): a phase III, open-label, mixed-methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction

Efficacy of Septoplasty in Patients with Nasal Obstruction: A Systematic Review and Meta‐analysis

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