Abstract
Background:
Nasal obstruction was a common symptom encountered in otolaryngology, arising from various etiologies, including both mucosal and structural factors.
Objective:
The aim of this study was to evaluate the quality of life of patients after nasal septoplasty.
Methods:
A prospective, longitudinal 6-month study was conducted on 52 patients who underwent septoplasty or rhinoplasty and were followed up at Hanoi Medical University Hospital from April 2023 to April 2024. The effectiveness of the surgery was assessed through clinical nasal symptoms, and the quality of life of patients was evaluated using the SF-36 Quality of Life Assessment Tool (Short Form-36).
Results:
In the study group, 27 (51.9%) patients were female. The nasal obstruction scores significantly decreased from preoperative (2.67 ± 0.47) to 1 month (1.1 ± 0.75) and 6 months (0.65 ± 0.68) postoperative (p<0.05). The facial pain scores significantly decreased from preoperative (1.46 ± 1.11) to 1 month (1.1 ± 1.05) and 6 months (0.79 ± 0.89) postoperative (p<0.05). The rhinitis scores significantly decreased from preoperative (1.42 ± 1.11) to 1 month (1.02 ± 1) and 6 months (0.77 ± 0.9) postoperative (p<0.05). The average quality of life scores according to the 8 factors of the SF-36 Quality of Life Assessment Tool increased at 1 month and 6 months postoperative. The differences were statistically significant (p<0.05).
Conclusion:
Nasal septoplasty significantly improves clinical symptoms and the quality of life of patients. The SF-36 is a reliable outcome measure for the success of nasal septal surgery.
Keywords: nasal septoplasty, quality of life, SF-36
1. BACKGROUND
Nasal obstruction was a common symptom encountered in otolaryngology, arising from various etiologies, including both mucosal and structural factors (1). One of the predominant structural causes was a deviated nasal septum, a condition characterized by the deformation of nasal bones and cartilage, resulting in reduced airflow through the nasal passages. The prevalence of nasal septum deviation was notably high, estimated to range from 30.9% to 65%, depending on the diagnostic criteria employed (2). While a deviated nasal septum could often be asymptomatic, it had the potential to induce significant clinical manifestations, including nasal congestion, recurrent sinusitis, and sleep disturbances such as snoring, mouth breathing, daytime sleepiness, and fatigue. These symptoms collectively had a profound impact on the patient's overall quality of life.
To mitigate these symptoms and enhance the quality of life, surgical intervention, specifically septoplasty, was often deemed necessary. Septoplasty involved the surgical correction of the deviated septum to widen the nasal airways and improve airflow. This procedure was frequently performed in conjunction with the reduction of the inferior turbinates to optimize surgical outcomes (1). Despite its common application, the efficacy of septoplasty remained a subject of debate within the medical community, as studies had reported mixed results regarding its success. Some investigations documented moderate to excellent outcomes, while others indicated a lack of patient satisfaction postoperatively (2-4).
The pivotal question addressed in this context was whether septoplasty genuinely improved the quality of life for patients after surgery. Comprehensive assessment of postoperative quality of life extended beyond mere respiratory function, encompassing psychological well-being, daily activities, and work performance (2-4). At Hanoi Medical University Hospital, nasal septum plastic surgery was routinely performed, providing relief to numerous patients. However, there was a noticeable gap in the literature regarding the evaluation of postoperative quality of life specific to this patient population.
Consequently, our study aimed to bridge this gap by systematically investigating the quality of life of patients following nasal septoplasty. The research, titled "Quality of life of patients after nasal septoplasty surgery," sought to provide empirical evidence on the multidimensional outcomes of septoplasty, thereby contributing to a more nuanced understanding of its benefits and limitations.
2. OBJECTIVE
Through this study, we aimed to offer valuable insights that could inform clinical practice and enhance patient care in the field of otolaryngology.
3. MATERIAL AND METHODS
Research participants
Patients who had undergone septoplasty or rhinoplasty surgery and were monitored at Hanoi Medical University Hospital consented to participate in the study.
Exclusion criteria:
History of previous septoplasty or rhinoplasty surgery.
Concurrent rhinoplasty surgery.
Nasal obstruction caused by factors other than a deviated nasal septum, including sinus disease, sinus malignancy, and nasopharyngeal hypertrophy.
Age under 18 years.
Period and location of research
Research period: from April 2023 to April 2024.
Research location: Hanoi Medical University hospital.
Research design
Prospective study, longitudinal follow-up.
The method of data collection
Sample collection method
A convenient sampling method was employed, wherein direct interviews were conducted with patients using a pre-constructed structured questionnaire. The study ultimately included a total of 52 patients.
Questionnaire
Patients were interviewed using the questionnaire, and the investigator recorded their responses. The SF-36 tool's 36 questions were categorized into 8 health domains and converted to a 100-point scale. Acoustic rhinometry and rhinomanometry tests were performed before surgery and repeated at the 1st and 6th months post-surgery
Evaluation of the effectiveness of septoplasty
The study assessed how effective septoplasty is in treating nasal symptoms such as nasal obstruction, severity of facial pain, and nasal inflammation using Ozlem's (2020) (5) tool, which rates symptoms on a Likert scale from 0 to 3 (0 for no symptoms, 1 for mild, 2 for moderate, and 3 for severe). Acoustic and nasal measurements were conducted on all patients before surgery and again in the first and sixth months after surgery.
The evaluation of patients' quality of life was conducted using the SF-36 Quality of Life Assessment Tool, which had been localized and validated in Vietnam (6). This tool consisted of 36 questions that assessed 8 health concepts: physical functioning, physical role limitations, pain, general health perceptions, vitality, social functioning, emotional role limitations, and mental health. It took 5-10 minutes for patients to complete the questionnaire. The questions were either "yes/no" comparisons or rated on a 6-point Likert scale from 'None' to 'Very severe'. The 36-point results were summarized and converted to a scale ranging from 0 (death) to 100% (completely healthy).
The interview method
The investigator directly questioning the patient, who then provided answers. The investigator recorded the patient's responses in the designated response section of the questionnaire
Research Ethics approval
The ethics of the research were reviewed and approved by the Ethics Committee of Hanoi Medical University and Hanoi Medical University Hospital. The research team conducted the study only with participants who had consented to join. All personal information of the participants was kept confidential. Personal data was encrypted and was accessible solely to the principal investigators who were directly responsible for quality control and data interpretation
4. RESULTS
In the research group, 27 patients, accounting for 51.9%, were female. Almost half of the participants, 46.2%, were between the ages of 31 and 40. The average age of the study participants was 32.75 years, with a standard deviation of 6.78 years (Table 1).
Table 1. General characteristics of study participants (n=52).
| Characteristics | Number (n) | Percentage (%) |
|---|---|---|
| Gender | ||
| Male | 25 | 48.1 |
| Female | 27 | 51.9 |
| Age group | ||
| 18-30 | 20 | 38.5 |
| 31-40 | 24 | 46.2 |
| >40 | 8 | 15.4 |
| Mean age ± SD | 32.75 (6.78) | |
The results indicated that the Nasal Obstruction score had significantly decreased from the pre-surgery level (2.67 ± 0.47) to 1 month (1.1 ± 0.75) and 6 months (0.65 ± 0.68) post-surgery (p<0.05). Similarly, the Facial Pain score had markedly decreased from the pre-surgery level (1.46 ± 1.11) to 1 month (1.1 ± 1.05) and 6 months (0.79 ± 0.89) post-surgery (p<0.05). Additionally, the Rhinitis score had significantly reduced from the pre-surgery level (1.42 ± 1.11) to 1 month (1.02 ± 1) and 6 months (0.77 ± 0.9) post-surgery (p<0.05) (Table 2).
Table 2. Results of evaluating the effectiveness of nasal septoplasty surgery intervention after 6 months (n=52).
| Characteristics | Before surgery | After 1 month | After 6 months | p |
|---|---|---|---|---|
| Unclogging nose Mean ± SD |
2.67 ± 0.47 | 1.1 ± 0.75 | 0.65 ± 0.68 | 0.001 |
| Degree of pain in the face Mean ± SD |
1.46 ± 1.11 | 1.1 ± 1.05 | 0.79 ± 0.89 | 0.001 |
| Rhinitis condition Mean ± SD |
1.42 ± 1.11 | 1.02 ± 1 | 0.77 ± 0.9 | 0.001 |
The Figure 1 showed significant improvements in patients' conditions after nasal septoplasty surgery. Before surgery, a large number of patients (35) reported severe nasal obstruction (3 points), but this number dropped to zero after six months. Similarly, the number of patients experiencing severe facial pain (3 points) decreased from 19 before surgery to just 2 after six months. Additionally, the number of patients with the most severe rhinitis symptoms (3 points) dropped from 14 before surgery to only 2 after six months. These findings indicate that nasal septoplasty effectively reduced nasal obstruction, facial pain, and rhinitis symptoms over time.
Figure 1. Number of patients according to results of nasal septoplasty surgery after 6 months.
Table 3 and Figure 2 illustrated that the average quality of life scores for patients, based on the 8 factors of the SF-36 Quality of Life Assessment Tool, had all improved 1 month and 6 months after surgery. The differences were statistically significant (p<0.05).
Table 3. Quality of life of patients after 6 months of septoplasty according to the SF-36 scale (n=52).
| Characteristics | Before surgery | After 1 month | After 6 months | p |
|---|---|---|---|---|
| Physical function | 28.9 ± 6.1 | 40.96 ± 7.94 | 46.04 ± 8.32 | 0.001 |
| Physical role limitation | 35.25 ± 3.04 | 48.35 ± 6.03 | 52.77 ± 5.78 | 0.001 |
| Bodily pain | 34.38 ± 9.32 | 47.33 ± 10.73 | 52.81 ± 10.22 | 0.001 |
| General perception of health | 39.85 ± 6.14 | 51.62 ± 7.34 | 56.92 ± 8.33 | 0.001 |
| Energy/vitality | 31.87 ± 6.12 | 44 ± 6.95 | 48.23 ± 6.68 | 0.001 |
| Social function | 29.08 ± 6.17 | 41.6 ± 6.93 | 45.96 ± 8.27 | 0.001 |
| Emotional role limitation | 29.83 ± 5.7 | 42.13 ± 7.16 | 47.88 ± 8.26 | 0.001 |
| General mental health | 44.04 ± 8.85 | 56.65 ± 10.5 | 62.08 ± 10.79 | 0.001 |
Figure 2. Quality of life of patients after 6 months of septoplasty according to the SF-36 scale (n=52).
5. DISCUSSION
It was observed that the quality of life for patients with a deviated septum was poorer compared to the general population (7). However, septoplasty had significantly improved the quality of life for these patients. There were also significant differences in nasal acoustic measurements and nasal pressure measurements before and after surgery, as well as in nasal morphology. Most patients believed septoplasty had benefited them (8). Bugten et al., had found significant improvement in nasal symptoms, reporting improvements in nasal obstruction (74% of patients), runny nose (64%), and facial pain (72%) (4). Unlike Bugten's study, our research showed that the majority of patients had improved scores on the general health questionnaire post-surgery. In our study, when comparing general nasal symptoms, all patients showed improvement after surgery. The improvement in nasal obstruction in our study favorably compared to other studies such as Bugten's, with a similar rate of 74% (4). Our research findings were higher than those of Erdivanli et al. (5). Their study, involving 82 patients who had undergone nasal septoplasty, revealed that, in the first month following surgery, scores for nasal obstruction, facial pain, and rhinorrhea had significantly improved (P < 0.0001). By the sixth month post-surgery, the scores had not shown a significant increase. Nasal volume had significantly increased and total resistance had significantly decreased by the sixth month (P < 0.0001). When compared to pre-surgery values, all items except for social functioning and bodily pain had significantly increased in the first month post-surgery. Compared to the values at the first month post-surgery, only the bodily pain score had decreased by the sixth month post-surgery (5).
Septoplasty outcome measures include the Nasal Obstruction Septoplasty Effectiveness (NOSE) study (9, 10), the Sinonasal Outcome Test-22 (SNOT-22) (11,12), and the Fairlay Nasal Symptom Score (13-15).
Manteghi et al. assessed the outcomes of septoplasty both pre- and post-operatively. A statistically significant decrease in NOSE scores was observed following both septoplasty and functional septorhinoplasty. The median NOSE score decreased from 75 pre-operatively to 20 post-operatively for septoplasty (z = -5.9, p < 0.001) and to 15 for functional septorhinoplasty (z = -7.9, p < 0.001) (10). Bezerra, et al. reported that, septoplasty resulted in a statistically significant improvement in the NOSE scores in the preoperative and after three months (9).
Shorook et al. conducted a randomized controlled trial comparing two approaches to septoplasty: endoscopic and TNTS septoplasty, with 30 patients in each group. The study evaluated SNOT-22 scores at three time points. Prior to surgery, patients in both groups had similar scores (mean 43.8 in the TNTS group and 46.2 in the endoscopic group, P = .64). The SNOT-22 scores showed continued improvement after surgery, with no significant difference between the groups at 3 months postoperatively (mean 21.8 in the TNTS group and 28.6 in the endoscopic group, P = .1) (11). Carrie et al. found in a randomized controlled trial on patients who underwent septoplasty that the mean SNOT-22 scores at six months were 19.9 in the septoplasty group (n=152) and 39.5 in the medical management group, showing a significant difference compared to baseline (p<.01) (12).
SF-36 was a general health assessment tool not specifically designed for nasal septum deviation, but it provided important information about an individual's functional health status and overall response to treatment. It was also a widely used self-administered questionnaire (6, 16, 17). Numerous studies had used SF-36 to evaluate treatments for chronic sinusitis, endoscopic sinus surgery, nasal polyps, middle turbinate resection, and allergic rhinitis. Shorook et al. conducted a randomized controlled trial comparing two approaches to septoplasty: endoscopic and TNTS septoplasty with 30 patients each arm. The total score (ranging from 1 to 100) significantly improved in the three months following surgery, with mean scores increasing from 65.8 to 81.4 (P < .001) for the entire cohort. At three months postoperative, both treatment groups demonstrated significant improvements in SF36 scores compared to preoperative levels (11). Patients undergoing septoplasty typically anticipate relief from nasal obstruction soon after surgery. SF-36 could be used as a reliable measure of the outcomes for successful nasal septum surgery.
The study has several limitations. As a longitudinal study, it lacks comparative data to fully evaluate the effectiveness of nasal septoplasty. It was conducted at a single center with a small sample size, limiting the generalizability of the results. Although the SF-36 is a well-established tool for measuring overall quality of life, and we supported our findings by using it to assess septoplasty outcomes, it is a self-reported survey. This introduces variability, as patients' individual perceptions can influence how they interpret and respond to the questions. Furthermore, there are limited studies evaluating the quality of life in patients after nasal septoplasty.
6. CONCLUSION
The values of nasal and acoustic measurements, along with the patients' symptoms, had significantly improved after the septoplasty. It was concluded that the SF-36 could be used as a reliable measure of the outcomes for successful nasal septum surgery.
Authors conribution:
The all authors were involved in all steps of preparation this article. Final proofreading was made by the first author.
Conflict of interest:
The authors affirm that they have no conflicts of interest to disclose.
Financial support and sponsorship:
The authors confirm that this study received no financial support.
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