2017-18 HSC Section 4 Green Book

Otolaryngology–Head and Neck Surgery 156(5)

Table 2. MINORS Scores for Included Studies by Criteria. a

End Points Appropriate to Aim of Study

Unbiased Assessment of

Follow-up Period Appropriate to Aim of Study

Prospective Calculation of Study Size

Clearly Stated Aim

Inclusion of Consecutive Patients

Prospective Collection of Data

Loss to Follow-up \ 5%

the Study End Point

MINORS Score b

Study

Anari (2012) 14 Deroee (2011) 15 Egan (2005) 16 Gunel (2015) 17 Illhan (2015) 18 Islam (2008) 19 Lindsay (2013) 22 Most (2006) 23 Rhee (2005) 24 Roofe (2007) 25 Surowitz (2015) 26 Kayabasoglu (2015) 20 Lavinsky-Wolff (2013) 21

15 15

2 2 2 2 2 2 1 2 2 2 2 2 2 1 2 2

2 2 0 1 1 1 1 2 1 1 2 2 1 1 2 1

2 2 0 2 2 1 1 2 2 2 2 2 2 2 2 1

2 2 1 2 1 2 1 2 2 2 2 2 2 2 1 2

1 2 1 1 1 1 1 2 2 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

2 2 2 2 2 2 2 2 1 2 1 1 2 2 2 2

2 1 0 1 1 0 1 2 0 0 2 2 1 2 1 0

8

13 12 11 10 16 12 12 14 14 13 13 13 11

Tan (2012) 27

Tastan (2011) 28 Yoo (2011) 29

Abbreviation: MINORS, Methodological Index for Non-randomized Studies. a Score per criterion: 0, not reported; 1, reported but inadequate; 2, reported and adequate. b Ideal global score for noncomparative study is 16.

*Note last line denotes combined data Figure 2. NOSE score improvement at 3-6 months. NOSE, Nasal Obstruction Symptom Evaluation.

SMD in this group was 1.30 (95% CI, 0.59-2.00), consistent with a large clinical change. At 6-12 months there was, again, a substantial change in NOSE scores ( Figure 3 ). Seven studies reported follow-up NOSE scores during this period, and the mean improvement was 43.4 (95% CI, 35.8-51.0), with high heterogeneity ( I 2 = 99). The SMD was 1.54 (95% CI, 0.95-2.13), also consistent with a very large clinical change. At 12 months, change in NOSE scores was more modest ( Figure 4 ). Four studies reported outcomes in this period.

Mean improvement was 48.7 (95% CI, 39.0-58.4), with high heterogeneity ( I 2 = 98). However, the SMD dropped 0.46 (95% CI, 0.11-0.81), which is consistent with a moder- ate clinical effect; however, given the range in CIs, a trivial effect could not be excluded. Discussion Many outcomes-based studies have examined the efficacy of functional rhinoplasty on the relief of nasal obstruction; however, the majority of these studies are case series or

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