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BACKGROUND: Studies have found that in healthy individuals without nasal disease, changes in posture cause an increase in nasal resistance, especially in the prone posture. Many patients with obstructive sleep apnea syndrome (OSAS) sleep in a prone posture, but no studies have examined the effect of this change in posture on nasal resistance in patients with OSAS. Therefore, we conducted this study to investigate this posture-related physical phenomenon in individuals with OSAS. METHODS: We evaluated the nasal patency of 29 patients diagnosed with OSAS using the visual analog scale (VAS), acoustic rhinometry, and video-endoscopy in the sitting, supine, and prone postures. RESULTS: In the OSAS group, both supine and prone postures significantly influenced subjective nasal blockage and led to a notable reduction in the minimal cross-sectional area (mCSA) as determined by acoustic rhinometry, compared to the sitting posture. The prone posture exhibited a more pronounced effect than the supine posture. Endoscopic evaluations further revealed increased hypertrophy of the inferior turbinate in the supine posture for the right nasal passage and the prone posture for the left. However, no significant differences were observed between the prone and supine postures. CONCLUSION: In OSAS patients, nasal resistance significantly increased in supine and prone postures compared to sitting, with the prone posture showing a greater effect. Clinicians should consider a patient's habitual sleep posture and the effects of postural changes when assessing OSAS severity and devising treatment plans.
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Endoscopía , Rinometría Acústica , Apnea Obstructiva del Sueño , Humanos , Apnea Obstructiva del Sueño/fisiopatología , Masculino , Persona de Mediana Edad , Posición Supina , Femenino , Adulto , Posición Prona , Sedestación , Obstrucción Nasal/fisiopatología , Resistencia de las Vías Respiratorias/fisiología , Anciano , Postura/fisiologíaRESUMEN
BACKGROUND: Cholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases. CASE PRESENTATION: This article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals. CONCLUSION: Cholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.
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Colesterol , Granuloma de Cuerpo Extraño , Seno Maxilar , Enfermedades de los Senos Paranasales , Tomografía Computarizada por Rayos X , Humanos , Masculino , Seno Maxilar/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Granuloma de Cuerpo Extraño/cirugía , Granuloma de Cuerpo Extraño/diagnóstico , Granuloma de Cuerpo Extraño/patología , Granuloma de Cuerpo Extraño/diagnóstico por imagen , Adulto Joven , Enfermedades de los Senos Paranasales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/diagnóstico , Endoscopía , Diagnóstico Diferencial , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugíaRESUMEN
RELEVANCE: Nasal congestion is one of the most common complaints in otolaryngology practice and can significantly impact the quality of life for patients. Objective and subjective assessments provide different information, but objective assessment of nasal obstruction is crucial for accurate diagnosis and appropriate treatment. This review demonstrates that peak nasal inspiratory flow (PNIF) is a reproducible and reliable measure of objective nasal patency. It is inexpensive, easy to use, suitable for serial measurements, and can be applied to patients of different age groups. PNIF is recommended for use in every outpatient clinic that treats patients with nasal congestion. OBJECTIVE: To summarize the data on the application of PNIF in diagnosing conditions of the nasal airways. MATERIAL AND METHODS: Publications (articles and relevant abstracts) available in the PubMed and eLibrary databases were analyzed. CONCLUSION: PNIF offers an objective and non-invasive assessment of nasal airflow, aiding in diagnosis, therapy monitoring, and preoperative planning. Further research, standardization, and establishment of normative data will enhance the informative value of peak nasal inspiratory flow in assessing nasal obstruction.
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Obstrucción Nasal , Humanos , Obstrucción Nasal/fisiopatología , Obstrucción Nasal/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: This study aimed to determine the effects of chronic intermittent hypoxia (CIH) and stress change (SC) on the development of the condyle in mouth breathing rats. DESIGN: A total of 120 4-week-old rats were randomly assigned to one of five groups. The control (Ctrl) group was the blank control and the intermittent nasal obstruction (INO) group was the positive control. Mild CIH (mCIH) and severe CIH (sCIH) groups were developed by adjusting environmental oxygen concentration and monitoring real-time blood oxygen saturation (SpO2). The SC group was developed using INO, increased environmental oxygen concentration, and real-time SpO2 monitoring. Six rats from each group were sacrificed for analysis at 0, 1, 2, or 4 weeks. RESULTS: Similar to the INO group, condyle and mandibular body development in the sCIH group, but not in the mCIH group, was significantly inhibited compared with the Ctrl group. The SC group had inhibited development of the condyle, especially of the posterior zone, but had minimal impact on the growth of the mandible. CONCLUSION: The inhibitory effects of CIH on the development of the condyle and mandibular body were SpO2-dose-dependent. When SC occurred, inhibited development was observed in the posterior zone of condyle but not the whole mandible. These findings provide important insights for targeted interventions that address the consequences of mouth breathing in children.
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Hipoxia , Cóndilo Mandibular , Animales , Hipoxia/fisiopatología , Ratas , Cóndilo Mandibular/crecimiento & desarrollo , Modelos Animales de Enfermedad , Ratas Sprague-Dawley , Masculino , Respiración por la Boca/fisiopatología , Distribución Aleatoria , Estrés Fisiológico/fisiología , Obstrucción Nasal/fisiopatología , MandíbulaRESUMEN
AIMS: To compare all-cause claims associated with the LATERA Absorbable Nasal Implant and surgical repair of nasal vestibular stenosis in patients with nasal valve collapse. METHODS: This retrospective cohort study utilized data from STATinMED RWD Insights. A defined set of HCPCS, ICD-10-CM and CPT codes were used to identify patients with ≥1 claim for a LATERA procedure, and patients with ≥1 claim for surgical repair between June 1, 2015- March 31, 2023. Patients with continuous capture for at least 12 months before and at least 6 months after the index date were selected. The index date was defined as earliest date of encounter for a LATERA or surgical repair procedure. Inverse probability of treatment weighting (IPTW) was used to ensure balance between cohorts. Descriptive analyses were provided for all claims data using standard summary statistics. All-cause claims were assessed during the baseline, index date, and follow-up period. Chi-squared tests and independent sample t-tests were used to assess differences in cohorts for categorical and continuous variables, respectively. RESULTS: The study population included 5,032 LATERA patients and 26,553 surgical repair patients. During the baseline and follow-up periods, the matched cohorts exhibited similar all-cause claims. On the index date, LATERA patients incurred lower claims vs. surgical repair, likely due to LATERA's ability to be implanted in the physician office setting. LATERA patients and surgical repair patients mean (SD) total costs were $9,612 [$14,930] vs $11,846 [$17,037] (p ≤ 0.0001), respectively. CONCLUSIONS: Treatment with the LATERA Absorbable Nasal Implant is a potentially cost saving option for payers on the index date compared to traditional surgical repair in patients with nasal valve collapse due to the ability to be performed in the office. All-cause claims were similar in the baseline and follow-up periods. When performed with concomitant procedures, all-cause claims during follow-up were similar between groups.
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Implantes Absorbibles , Revisión de Utilización de Seguros , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Obstrucción Nasal/cirugía , Anciano , Gastos en Salud/estadística & datos numéricosRESUMEN
The article presents the results of a study that included 127 children aged 8 to 17 years with a diagnosis of turbinate hypertrophy. The children are divided into three groups depending on the chosen vasotomy method. The methods of vasotomy were determined, after which there was a faster restoration of mucociliary clearance of the mucous membrane of the lower nasal concha.
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Hipertrofia , Depuración Mucociliar , Mucosa Nasal , Cornetes Nasales , Humanos , Depuración Mucociliar/fisiología , Cornetes Nasales/cirugía , Niño , Femenino , Masculino , Adolescente , Mucosa Nasal/cirugía , Mucosa Nasal/fisiopatología , Hipertrofia/fisiopatología , Hipertrofia/cirugía , Resultado del Tratamiento , Obstrucción Nasal/cirugía , Obstrucción Nasal/fisiopatología , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/etiologíaRESUMEN
Background: The Nasal Obstruction Symptom Evaluation (NOSE) is a questionnaire to assess patients with nasal obstruction. The aim of this study was to translate and validate NOSE to the Malay version NOSE (M-NOSE). Methods: The NOSE questionnaire was translated to Malay language and back to English. Psychometric properties consisting of reliability, reproducibility, validity, responsiveness were appraised in patients with nasal obstruction due to deviated nasal septum and healthy asymptomatic controls. Results: A total of 126 participants were recruited. There was significant difference between patients and controls for all items and the total score (all p < 0.001). The correlation was moderate to strong between all items and total score (r = 0.71 to 0.8) and fair to moderate for the inter-items correlations (r= 0.31 to 0.70). Internal consistency for M-NOSE was good (α = 0.81). The test-retest for each item demonstrated no significant difference. There was significant difference of the pre- and post-operative mean for each item and total score (all p < 0.001) with good response sensitivity (effect size, d = 4.91). Conclusions: The M-NOSE has satisfactory reliability, internal consistency, reproducibility and responsiveness. It is a valid and convenient tool in the assessment of the impact and treatment outcome of nasal obstruction.
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Obstrucción Nasal , Psicometría , Humanos , Obstrucción Nasal/diagnóstico , Femenino , Masculino , Reproducibilidad de los Resultados , Malasia , Adulto , Encuestas y Cuestionarios , Psicometría/métodos , Persona de Mediana Edad , Traducciones , Evaluación de Síntomas/métodos , Adulto Joven , TraducciónRESUMEN
OBJECTIVE: The aim of this study was to compare the nasal airway resistance between the cleft and non-cleft sides in operated unilateral cleft lip (UCL) patients with varying severities at birth, as well as to assess the differences in nasal airway resistance between UCL patients and healthy individuals. METHODS: This retrospective study was conducted on 112 UCL patients who have undergone primary lip reconstructions but not advanced surgeries as the study group and 20 healthy participants as the control group between February 2023 to March 2024. The study group patients were grouped based on the severity of their cleft lip at birth, divided into occult cleft lip group, incomplete cleft lip group, and complete cleft lip group. The anterior rhinomanometry was used to evaluate nasal resistance, including unilateral effective resistances during inspiration (Reffin), expiration (Reffex), and the entire breath (ReffT), as well as unilateral vertex resistance during inspiration (VRin) and expiration (VRex). The Kolmogorov-Smirnov test was used to assess normality. Paired t-tests were utilized to analyze the differences in nasal resistance between the healthy and affected sides within the same group of patients. Student's t-test was used to analyze the differences in nasal resistance among patients with different degrees of cleft lip. A p-value of <0.05 was considered statistically significant. RESULTS: The nasal resistances of the occult cleft and incomplete cleft lip groups showed no significant differences between the cleft and non-cleft sides, and were similar to the control group. However, in the complete cleft lip group, the cleft side nasal resistance was significantly higher than the non-cleft side and control group. Among the groups, the complete cleft lip group had significantly higher nasal resistances on the cleft side for Reffin, VRin, and ReffT compared to the occult cleft group. CONCLUSION: Understanding the nasal resistance of different degrees of operated UCL patients can benefit clinical diagnosis and treatment. Patients with complete cleft lip have more severe nasal obstruction on the cleft side, with greater impact on inhalation than exhalation. For these patients, treatment by an otolaryngologist is recommended to improve nasal airflow.
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Resistencia de las Vías Respiratorias , Labio Leporino , Rinomanometría , Humanos , Labio Leporino/cirugía , Labio Leporino/fisiopatología , Estudios Retrospectivos , Masculino , Femenino , Resistencia de las Vías Respiratorias/fisiología , Estudios de Casos y Controles , Lactante , Niño , Procedimientos de Cirugía Plástica/métodos , Obstrucción Nasal/cirugía , Obstrucción Nasal/fisiopatología , PreescolarAsunto(s)
Tabique Nasal , Rinoplastia , Humanos , Rinoplastia/métodos , Tabique Nasal/cirugía , Femenino , Masculino , Obstrucción Nasal/cirugía , Obstrucción Nasal/etiología , AdultoRESUMEN
A man in his 60s presented with diminution of vision of the left eye with nasal bleeding after accidental fall. On examination his left upper eyelid was lacerated and left temporal sclera was punctured which was repaired under local anaesthesia after which he was discharged by ophthalmologists but continued to complain of pain and left nasal obstruction. A non-contrast CT of paranasal sinuses revealed fracture of medial wall of left orbit, left ethmoid haemosinus and a metallic foreign body (FB) in the septum and anterior face of sphenoid. Diagnostic nasal endoscopy performed to remove the metallic FB showed plastic splinters embedded in the mucosa of nasal cavity which was unexpected. Hence, the FB was removed in two sittings because of diagnostic dilemma.
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Cuerpos Extraños , Humanos , Masculino , Persona de Mediana Edad , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/complicaciones , Tomografía Computarizada por Rayos X , Nariz/lesiones , Accidentes por Caídas , Fracturas Orbitales/cirugía , Lesiones Oculares/complicaciones , Lesiones Oculares/cirugía , Lesiones Oculares/etiología , Endoscopía/métodos , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugía , Órbita/lesiones , Órbita/diagnóstico por imagen , Lesiones Oculares Penetrantes/cirugía , Lesiones Oculares Penetrantes/diagnóstico por imagen , Lesiones Oculares Penetrantes/complicacionesRESUMEN
OBJECTIVE: The objective of this study was to retrospectively assess the effect of Radiofrequency Volumetric Tissue Reduction (RFVTR) on hypertrophic turbinates and clinical outcome in brachycephalic dogs when included in multi-level surgery (MLS). STUDY DESIGN: Clinical retrospective multicenter study. ANIMALS: 132 client-owned brachycephalic dogs. METHODS: 132 brachycephalic dogs with high-grade Brachycephalic Obstructive Airway Ayndrome (BOAS) and hypertrophic turbinates were treated with RFVTR as part of MLS of the upper airways. Intranasal obstruction was evaluated by computer tomography (CT) and antero-/retrograde rhinoscopy before and 6 months after RFVTR. The clinical records, the CT images and the rhinoscopy videos were reviewed and clinical evolution was evaluated using a standardized questionnaire. The data was scored semi-quantitatively. RESULTS: In this study, 132 patients were included for a follow-up period of 120 weeks. RFVTR resulted in minor complications, including serous nasal discharge within the first postoperative week in all dogs, and intermittent nasal congestion between 3-8 weeks after treatment in 24.3% of the patients. Rhinoscopy and CT follow-ups were available for 33 patients. Six months after treatment intranasal airspace was increased (p = 0.002) and the presence and overall amount of mucosal contact points was reduced (p = 0.039). CONCLUSION: MLS with RFVTR led to a significant reduction in turbinate volume at the 6-month follow-up examination and significant clinical improvement over a long-term period of 120 weeks. This suggests the viability of RFVTR as a turbinate-preserving treatment for intranasal obstruction in dogs with BOAS. CLINICAL SIGNIFICANCE: RFVTR is a minimally invasive turbinoplasty technique for intranasal obstruction in dogs with BOAS and can be included in MLS without increasing complication rates.
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Enfermedades de los Perros , Cornetes Nasales , Animales , Perros , Cornetes Nasales/cirugía , Cornetes Nasales/patología , Cornetes Nasales/diagnóstico por imagen , Estudios Retrospectivos , Enfermedades de los Perros/cirugía , Enfermedades de los Perros/diagnóstico por imagen , Masculino , Femenino , Obstrucción Nasal/cirugía , Obstrucción Nasal/veterinaria , Obstrucción Nasal/patología , Hipertrofia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Obstrucción de las Vías Aéreas/veterinaria , Obstrucción de las Vías Aéreas/cirugía , Obstrucción de las Vías Aéreas/diagnóstico por imagenRESUMEN
OBJECTIVES: Investigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention. METHODS: CT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared. RESULTS: In the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery. CONCLUSION: CFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.
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Simulación por Computador , Hidrodinámica , Obstrucción Nasal , Rinomanometría , Tomografía Computarizada por Rayos X , Humanos , Obstrucción Nasal/cirugía , Obstrucción Nasal/congénito , Recién Nacido , Constricción Patológica/cirugía , Cavidad Nasal/anomalías , Cavidad Nasal/cirugía , Cavidad Nasal/diagnóstico por imagen , Imagenología Tridimensional , Masculino , FemeninoRESUMEN
OBJECTIVE: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient's history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis. METHODS: A retrospective review was conducted on this patient's electronic medical record. RESULTS: The patient's life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them. CONCLUSION: This case contributes to the understanding of MCL's diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes.
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Leishmaniasis Mucocutánea , Humanos , Femenino , Persona de Mediana Edad , Leishmaniasis Mucocutánea/diagnóstico , Leishmaniasis Mucocutánea/complicaciones , Obstrucción Nasal/etiología , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/cirugía , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/diagnóstico , Sinusitis/diagnóstico , Sinusitis/complicaciones , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/diagnóstico , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Diagnóstico DiferencialRESUMEN
OBJECTIVES: To compare and measure post-operative outcomes among various surgical techniques for reducing inferior turbinate hypertrophy (ITH), and to identify the factors associated with the clinical outcomes of turbinoplasty in patients with this condition. METHODS: A cross-sectional study was carried out from January 2021 to December 2022 at the Otorhinolaryngology Department of King Abdulaziz Medical City in Riyadh, Saudi Arabia. A total of 301 adult patients with ITH were included and were divided into different groups. Postoperative follow-up assessments were completed after one week, one month, and 6 months to evaluate outcomes and complications associated with each surgical technique; descriptive analysis, cross-tabulation, and exact logistic regression were utilized as data analysis methods. RESULTS: Most patients in both groups experienced partial or complete improvement after surgery, with 92% showing positive outcomes. Common clinical signs included deviated nasal septum deviation and external nasal deformity, while nasal obstruction was most frequently reported as the primary symptom. Post-surgery bleeding occurred in 3.7% of cases; no adhesions were noted. Microdebrider, medial flap, out-fracture, and submucosal diathermy techniques all demonstrated significantly higher improvement rates than others. CONCLUSION: The identified techniques with higher improvement rates offer evidence-based guidance for selecting optimal surgical approaches, while the study's limitations warrant further prospective research to validate these findings. Ultimately, it contributes valuable knowledge to the field of otorhinolaryngology, aiming to enhance patient outcomes and improve the management of ITH worldwide.
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Hipertrofia , Obstrucción Nasal , Cornetes Nasales , Humanos , Cornetes Nasales/cirugía , Estudios Transversales , Masculino , Femenino , Adulto , Hipertrofia/cirugía , Resultado del Tratamiento , Obstrucción Nasal/cirugía , Persona de Mediana Edad , Arabia Saudita , Complicaciones Posoperatorias/epidemiología , Colgajos Quirúrgicos , Tabique Nasal/cirugía , Adulto Joven , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/epidemiologíaRESUMEN
Nasal airflow obstruction correlates with several ailments, such as higher patency, increased friction at the mucosal wall or the so-called Little's area, improper air conditioning, and snoring. Nasal dilators are frequently employed, mainly due to their ease of access and use, combined with their non-permanent and non-surgical nature. Their overall efficacy, however, has not been clearly demonstrated so far, with some studies reporting conflicting outcomes, mainly because being based on subjective evaluations. This study employs Computational Fluid Dynamics simulations to analyze the flow inside a real nose, performs an objective assessment of a nasal dilator's effect in terms of airflow and air conditioning, reporting flow paths, friction levels, heat and water fluxes and detailed temperature and humidity distributions. Coincidentally, the studied nose presents a septal deviation, with one nostril being wider than the other. The tubes of the dilator used in both nostrils are identical, as with any standard commercial dilator. Consequently, the dilator widens one nostril, as intended, but results in an obstruction in the other. This allows simultaneously addressing two situations, the nominal function of the dilator, as well as an off-design case. Results indicate a 24 % increase in nasal patency in the design situation. The effect, however, is limited, as quantified by appropriate measures, such as the flow-generated friction at the nose surfaces and the temperature fluxes. Hence, the effect of such a dilator in nominal conditions is perhaps not as large as might be hoped. In the off-design situation, nasal resistance increases by 62 %, an undesirable effect, illustrating the consequences of using an inappropriate dilator.
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Simulación por Computador , Humanos , Dilatación/instrumentación , Modelos Biológicos , Obstrucción Nasal/fisiopatología , Cavidad Nasal/fisiología , Hidrodinámica , Nariz/fisiologíaRESUMEN
BACKGROUND: Granulomatosis with polyangiitis (Wegener's granulomatosis) causes progressive nasal collapse, nasal obstruction, and central face deformity. It is not known whether cartilaginous nasal reconstruction should be performed immediately or delayed until after disease "burnout." OBJECTIVES: The aims of this research regarding nasal collapse due to Wegener's granulomatosis were to (1) assess the functional and aesthetic outcomes following immediate vs delayed nasal reconstruction; and (2) measure the impact of psychosocial well-being (anxiety, depression, social isolation) in immediate vs delayed nasal reconstruction. METHODS: Wegener's patients with either immediate or delayed nasal surgery (n = 61) were compared. Functional and aesthetic severity were compared with the validated Standard Cosmesis and Health Nasal Outcome Survey (SCHNOS) score (t test). In addition, Patient-Reported Outcomes Measurement Information System (PROMIS) perioperative and 1-year follow-up surveys were analyzed. RESULTS: At initial consultation, SCHNOS score severity types were similar for both groups (immediate vs delayed): mild 15% vs 15%; moderate 59% vs 60%, and severe 26% vs 25%. Over a 30 ± 4 month period, delayed surgery patients' conditions deteriorated, with a shift from mild to more severe SCHNOS scores, from 25% severe at initial consultation to 85% before surgery. PROMIS scores at presentation were high compared to the general public; by the time of delayed surgery, patients had significantly worsened: anxiety from 28 to 73; depression from 18 to 62; and social isolation from 20 to 80. Although both immediate and delayed groups improved after surgery in functional and psychosocial scores, the immediate surgery group's improvement was superior. CONCLUSIONS: Data showed superior functional and aesthetic scores and superior psychosocial indicators with immediate cartilaginous nasal reconstruction, compared with waiting until disease burnout to undergo surgery.
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Granulomatosis con Poliangitis , Medición de Resultados Informados por el Paciente , Rinoplastia , Humanos , Granulomatosis con Poliangitis/cirugía , Granulomatosis con Poliangitis/diagnóstico , Granulomatosis con Poliangitis/complicaciones , Femenino , Masculino , Rinoplastia/métodos , Rinoplastia/psicología , Rinoplastia/efectos adversos , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Estética , Anciano , Tiempo de Tratamiento , Índice de Severidad de la Enfermedad , Estudios Retrospectivos , Factores de Tiempo , Deformidades Adquiridas Nasales/cirugía , Deformidades Adquiridas Nasales/etiología , Deformidades Adquiridas Nasales/psicología , Estudios de Seguimiento , Depresión/etiología , Depresión/diagnóstico , Depresión/psicología , Obstrucción Nasal/cirugía , Obstrucción Nasal/etiología , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/psicología , Ansiedad/etiología , Ansiedad/diagnóstico , Ansiedad/psicologíaRESUMEN
The studyCarrie S, O'Hara J, Fouweather T, et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 2023;383:e075445.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/surgery-is-better-than-nasal-sprays-for-people-with-severely-blocked-airways/.
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Obstrucción Nasal , Tabique Nasal , Rociadores Nasales , Humanos , Tabique Nasal/cirugía , Obstrucción Nasal/cirugía , Obstrucción Nasal/etiología , Rinoplastia/métodos , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Deviations of the septal wall are widespread anatomic anomalies of the human nose; they vary significantly in shape and location, and often cause the obstruction of the nasal airways. When severe, septal deviations need to be surgically corrected by ear-nose-throat (ENT) specialists. Septoplasty, however, has a low success rate, owing to the lack of suitable standardized clinical tools for assessing type and severity of obstructions, and for surgery planning. Moreover, the restoration of a perfectly straight septal wall is often impossible and possibly unnecessary. This paper introduces a procedure, based on advanced patient-specific Computational Fluid Dynamics (CFD) simulations, to support ENT surgeons in septoplasty planning. The method hinges upon the theory of adjoint-based optimization, and minimizes a cost function that indirectly accounts for viscous losses. A sensitivity map is computed on the mucosal wall to provide the surgeon with a simple quantification of how much tissue removal at each location would contribute to easing the obstruction. The optimization procedure is applied to three representative nasal anatomies, reconstructed from CT scans of patients affected by complex septal deviations. The computed sensitivity consistently identifies all the anomalies correctly. Virtual surgery, i.e. morphing of the anatomies according to the computed sensitivity, confirms that the characteristics of the nasal airflow improve significantly after small anatomy changes derived from adjoint-based optimization.