Nilsen Ann Helen, Helvik Anne-Sofie, Thorstensen Wenche Moe, Bugten Vegard
1Department of Ear, Nose and Throat, Head and Neck Surgery, St Olavs University Hospital, 7006 Trondheim, Norway.
2Institute of Public Health and General Practice, Norwegian University of Science and Technology, 7006 Trondheim, Norway.
BMC Ear Nose Throat Disord. 2018 Jan 26;18:2. doi: 10.1186/s12901-017-0050-z. eCollection 2018.
The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery.
All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups.
Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 and group-3 which reported more problems in the ear/facial--subset of SNOT-20 and in the general-mental-health-domain of SF-36 than group-1 .Postoperatively all patient groups reported improved symptom scores of nasal obstruction, nasal discharge, snoring, oral breathing and reduced general health and better HQOL Patients in group-2 had less symptoms of nasal obstruction than group-3 . Postoperative symptom score for nasal obstruction was 29.1 (SD67.6) in group-1, 27.5 (SD22.5) in group-2 and 37.2 (SD24.8) in group-3. Revision cases reported more nasal obstruction postoperatively; 41.3 (SD27) than non revision cases; 28.6 (SD24) The HQOL after surgery was about the same in all three patient groups, but we found that patients with comorbidities as sleep apnea and asthma reported worse HQOL than other patients
Surgical treatment of nasal obstruction led to less symptoms and better HQOL for all three patient groups. Comparing the postoperative scores between the patient groups we find that all groups reached the same level of HQOL. Regarding symptoms, the patients who underwent septoplasty combined with RFIT reported postoperatively less nasal obstruction than patients who underwent RFIT alone which may indicate that a combined procedure of septoplasty and RFIT is better than RFIT alone to treat nasal obstruction. Furthermore, revision cases, patients with sleep apnea and asthma patients seem to have poorer outcome after surgery than other patients. Both disease specific and general QOL instruments add valuable information for identifying factors influencing outcome.
本研究的主要目的是比较57例行鼻中隔成形术的患者（第一组）、56例行鼻中隔成形术联合下鼻甲射频治疗（RFIT）的患者（第二组）和58例仅行RFIT的患者（第三组）术前和术后的症状及健康相关生活质量（HQOL）。次要目的是调查这三组患者术后症状和HQOL的变化是否存在差异。
所有患者在手术前及术后6个月通过视觉模拟量表（VAS）报告症状，并通过鼻-鼻窦结局测试-20（SNOT-20）和简短健康调查-36（SF-36）报告HQOL。比较三组患者组内及组间术前和术后的评分及改善情况。
术前，三组患者的症状负担和HQOL相当相似，但第一组报告的口呼吸症状比第三组多，第三组在SNOT-20的耳/面部亚组以及SF-36的一般心理健康领域报告的问题比第一组多。术后，所有患者组均报告鼻塞、流涕、打鼾、口呼吸等症状评分改善，总体健康状况下降，HQOL改善。第二组患者的鼻塞症状比第三组少。第一组术后鼻塞症状评分为29.1（标准差67.6），第二组为27.5（标准差22.5），第三组为37.2（标准差24.8）。翻修病例术后鼻塞症状更多；为41.3（标准差27），而非翻修病例为28.6（标准差24）。三组患者术后的HQOL大致相同，但我们发现合并睡眠呼吸暂停和哮喘等合并症的患者报告的HQOL比其他患者差。
对所有三组患者而言鼻腔阻塞的手术治疗均使症状减轻，HQOL改善。比较患者组术后评分发现，所有组的HQOL达到相同水平。在症状方面，行鼻中隔成形术联合RFIT的患者术后鼻塞症状比仅行RFIT 的患者少，这可能表明鼻中隔成形术与RFIT联合手术治疗鼻腔阻塞比单纯RFIT更好。此外，翻修病例、睡眠呼吸暂停患者和哮喘患者术后结局似乎比其他患者更差。疾病特异性和一般生活质量评估工具均为识别影响结局的因素提供了有价值的信息。
