Elsevier

Auris Nasus Larynx

Volume 32, Issue 4, December 2005, Pages 369-374
Auris Nasus Larynx

Long term results following nasal septal surgery: Focus on patients’ satisfaction

https://doi.org/10.1016/j.anl.2005.05.011Get rights and content

Abstract

Objective:

The patient selection for septoplasty usually relies on clinical judgement alone. It is not clear, if surgeons’ selection criteria are able to accurately anticipate patients’ long term satisfaction as only a few studies exist on the outcome of nasal septal surgery. In this study, we analyze patients’ long term satisfaction following septoplasty based on their subjective opinion.

Materials and methods:

In this prospective study, 67 consecutive patients, who underwent septoplasty during one year in a District General Hospital, were included. We used the fairley nasal symptom questionnaire (FNQ) preoperativeiy and postoperatively and the Glasgow benefit inventory (GBI) postoperatively to assess the outcome. Patients were mailed two questionnaires 2–3 years postoperatively, to evaluate their perception of the procedure's long term results. As a criterion to measure the success of the operation we used the median postoperative FNQ score and patients were divided into two groups, consisting of patients with more and less successful result, respectively.

Result:

Fifty-one patients responded (76%). Analysis of the outcomes revealed significant improvement of total nasal symptom score (FNQ) postoperatively (from mean score 13.25 to 9.09) with significant benefit in the nasal obstruction, sore throat and the sense of smell but not for headaches. Significant improvement in nasal breathing was recorded mainly from patients with anterior septal deviation. Patients in the below criterion group (49%) had a mean GBI total score of 6.3, reporting no satisfaction after surgery, whereas patients in the above criterion group (51%) had a mean of 23.8, which is also not a satisfactory result. Social and physical components of GBI had no difference between groups having considerably low scores.

Conclusion:

The principal benefits of septal surgery are related to improvement in nasal symptoms. In this study GBI results did not reflect a significant change in health status from septoplasty even in the above criterion group. The significant percentage of patients who did not report satisfaction in the long term, questions the objectivity of surgeons’ criteria regarding nasal septal surgery. It also indicates that positive evaluation by patients of septal surgery outcome tends to be attenuated with time.

Introduction

Nasal obstruction is the most common chronic complaint in every-day rhinological practice. The clinician is often confronted with the question whether the presence of a septal deformity is the main cause of the obstruction. The answer is not always clear. Surgeons often trust their subjective assessment regarding the severity of the nasal obstruction in order to decide on therapeutic management, which often involves surgery. It is therefore not surprising that some investigators criticise the number of unnecessary septoplasties performed each year [1]. Accurate preoperative evaluation is very important as other causes of nasal obstruction frequently tend to be underestimated when the surgeon focuses his attention to an obviously deviated septum. On the other hand patients’ expectations from surgery are often different from those of surgeons’.

The aim of this study was to analyze the long term outcome of nasal septal surgery using previously published standardized questionnaires. We assessed the impact of surgery on patient's general health status and quality of life, and evaluated the accuracy of patients’ selection for septal surgery as depicted by the patients’ satisfaction 2–3 years postoperatively.

Section snippets

Materials and methods

In this prospective study we included 67 consecutive patients, who underwent septoplasty over a one-year period (January–December 2001) in a District General Hospital. Fifty-three percent were male and fourty percent were female with a mean age of 29.2 years (age range 18–55 years).

Patients, who underwent other ENT procedures such as surgery to the inferior turbinates, rhinoplasty and sinus surgery concomitant to septal surgery, were excluded from this study.

The assessment of patients included

Results

Information about the study and questionnaires were mailed to ail 67 patients, who underwent septopiasty. We were unable to locate two patients who changed their address after surgery. During the first month from the initial mail, 44 patients responded and returned the questionnaires. Seven more patients responded to our second mail giving a final response rate of 76% (51 patients). We consider these responders to be representative of the characteristics of the entire group of patients, because

Discussion

Outcome research is becoming a significant factor in analysis of clinical practice, and many authors have reported septoplasty outcome results. However, many of them were retrospective, some were not patient oriented assessments, and others used non-validated questionnaires [5], [6], [8], [9], [10]. Studies on patients’ satisfaction reported high satisfaction levels after septoplasty, but their results were postoperative evaluation in the short-term [6], [8].

This study is prospective with a

Conclusion

The principal benefits of septal surgery are related to improvement in nasal symptoms. In this study GBI results did not reflect a significant change in health status from septoplasty even in the above criterion group. The significant percentage of patients who did not report satisfaction in the long term poses a question regarding the objectivity of surgeons’ criteria for nasal septal surgery. It also indicates that positive evaluation by patients of septal surgery outcome tends to be

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