September 2019 HSC Section 1 Congenital and Pediatric Problems

Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2018; 111:16-20.

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Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology

journal homepage: www.elsevier.com/locate/ijporl

Pediatric septoplasty and functional septorhinoplasty: A quality of life outcome study

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Alexander Manteghi a , b , ∗ , Hena Din a , Nour Bundogji a , Shelby C. Leuin a , b a Division of Pediatric Otolaryngology, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA b University of California San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA

A R T I C L E I N F O

A B S T R A C T

Objective: This study assessed disease-speci fi c quality-of-life outcomes among pediatric patients undergoing septoplasty or functional septorhinoplasty. The Nasal Obstruction Symptom Evaluation (NOSE) score was ob- tained pre- and post-operatively. Additional analyses determined whether demographics, nasal trauma, prior nasal surgery, or allergic rhinitis history a ff ected NOSE scores. Methods: Patients undergoing septoplasty or functional septorhinoplasty were evaluated prospectively at a tertiary children's hospital. NOSE scores were assessed pre- and post-operatively. Change in NOSE score was analyzed using the Wilcoxon Signed Rank test, while multiple regression analysis evaluated factors associated with NOSE score change. Results: 136 patients (mean age 15.7 ± 2.1 years) were evaluated; 52 (38.2%) underwent septoplasty while 84 (61.8%) underwent functional septorhinoplasty. Mean follow-up was 3.6 ± 5.1 months. There was a statisti- cally signi fi cant decrease in NOSE score from pre-operative septoplasty and functional septorhinoplasty: median =75 to post-operative septoplasty: median = 20 (z = − 5.9, p < 0.001) and functional septorhino- plasty: median = 15 (z = − 7.9, p < 0.001). Gender, age, nasal trauma, prior nasal surgery, and allergic rhinitis did not have a signi fi cant e ff ect on NOSE score change for either group. Additional surgery at the time of procedure was not a confounding variable in the relationship between surgery type and NOSE score. A NOSE Scale reliability analysis demonstrated high internal consistency with Cronbach's α of 0.83 across septoplasty and functional septorhinoplasty patients. Conclusion: There was signi fi cant improvement in disease-speci fi c quality-of-life in pediatric patients under- going septoplasty or functional septorhinoplasty. Gender, nasal trauma, prior nasal surgery, and allergic rhinitis did not signi fi cantly a ff ect NOSE scores in either group.

Keywords: NOSE scale Quality-of-life Pediatric Septoplasty

Septorhinoplasty Nasal obstruction

1. Introduction

growth, the two most signi fi cant being the fi rst two years of life and at puberty [ 10 ]. The end of nasal growth is at approximately 12 – 16 years of age in girls and 15 – 18 years of age in boys [ 11 – 13 ]. In the presence of signi fi cant nasal obstruction, nasal surgery may be performed to prevent the aforementioned complications. Objective outcome measures, such as acoustic rhinometry, have demonstrated improvement following pediatric septoplasty [ 14 ], however the value of this testing is questionable. Rhinometry has shown poor test-retest consistency, possibly secondary to the variability of the nasal cycle and the multiple mediators of nasal congestion [ 15 – 18 ]. Physical examination fi ndings are subjective and susceptible to examination bias. Objective measures frequently do not correlate well with each other nor adequately represent patient symptomatology [ 19 ]. The aim of this study is to evaluate pre- and post-operative quality-

Septoplasty and functional septorhinoplasty (FSR) are procedures commonly performed in adults to relieve nasal obstruction and improve nasal air fl ow. They are less commonly performed in the pediatric po- pulation due to controversy regarding nasal surgery and concerns over potential adverse e ff ects on midface and nasal growth [ 1 ]. However, studies have shown that pediatric patients undergoing septoplasty or FSR have craniofacial growth measurements similar to normative data, even after long-term follow-up [ 2 – 7 ]. Furthermore, it has been shown that delaying surgical correction of a deviated septum may cause chil- dren to develop dental misalignment, abnormal facial growth, and worsening progression of respiratory issues [ 8 , 9 ]. Nonetheless, the timing of pediatric septoplasty and FSR is controversial. Nasal growth continues until early adulthood with periods of faster

∗ Corresponding author. Present address: 160 East Erie Avenue, Philadelphia, PA 19134, USA. E-mail address: alex.manteghi@tenethealth.com (A. Manteghi).

https://doi.org/10.1016/j.ijporl.2018.05.016 Received 5 April 2018; Received in revised form 10 May 2018; Accepted 10 May 2018

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