Sen Indranil, Dutta Mainak, Haldar Dibakar, Sinha Ramanuj
Department of Otorhinolaryngology and Head-Neck Surgery, Midnapore Medical College and Hospital, Midnapore, India.
Ear Nose Throat J. 2017 Feb;96(2):E6-E12. doi: 10.1177/014556131709600212.
Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.
鼻中隔手术患者选择不当往往会导致治疗失败，因此在手术前和术后随访中需要进行客观的鼻阻塞评估，以便应用于常规耳鼻喉科实践。本研究的目的是评估一种经济有效的设备在选择鼻中隔手术患者和评估术后结果时，对鼻气道分隔进行客观测量的有用性。在一家三级医疗教学机构进行了一项基于医院的前瞻性观察性研究，涉及74名等待鼻中隔手术的患者。每位患者在手术前、术后两次使用一种新设备鼻气道分隔仪（NAPM）进行鼻阻塞主观评估（采用鼻阻塞症状评估（NOSE）量表）和鼻分隔比（NPR）客观测量。总体而言，术前评估时，平均NOSE评分为66.42±9.42，NPR值为0.57±0.18（相关系数0.441）。74名患者中有60名NPR和NOSE评分均较高（第1组），但其余14名患者尽管NOSE评分较高，但NPR值较低（第2组）。术后，第1组的NOSE评分和NPR值显著降低。相比之下，第2组的参与者在相同手术操作后，两个参数的值均未改变。然而，第1组中有2名患者的NOSE评分和NPR值未改变，而第2组中有1名患者术后NOSE评分降低。因此，计算得出新设备识别因鼻阻塞需要接受鼻中隔手术患者的有效性为敏感性96.7%，特异性92.9%。从本研究可以推断，鼻气道分隔仪可以成为临床医生客观测量鼻气道阻塞并筛选鼻中隔手术患者的一种经济有效的设备。
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