2017-18 HSC Section 4 Green Book

Floyd et al

*Note last line of figure denotes combined data Figure 3. NOSE score improvement at 6-12 months. NOSE, Nasal Obstruction Symptom Evaluation.

*Note last line of figure denotes combined data Figure 4. NOSE score improvement at 12 months. NOSE, Nasal Obstruction Symptom Evaluation.

retrospective reviews, which are subjective in nature and lack validated measurements of nasal obstruction. 3,8-13 Despite these limitations, all of these prior studies have sug- gested that functional rhinoplasty does improve the nasal airway in appropriately selected patients. Our analysis supports these findings, showing that nasal obstruction, as measured by the NOSE survey, is substan- tially reduced for at least 12 months after functional rhino- plasty. Patients in the 16 included studies had moderate to severe nasal obstructive symptoms at baseline, with a mean pooled NOSE score of 67 (95% CI, 61-74), with 100 being the highest level of severity. This is similar to baseline scores observed in the trial evaluating septoplasty by Stewart et al. 1 NOSE scores were substantially improved at 3-6 (6 studies), 6-12 (7 studies), and 12 months (4

studies), with absolute reductions of 50 (95% CI, 45-54), 43 (95% CI, 36-51), and 49 points (95% CI, 39-58), respec- tively. All of these analyses showed high heterogeneity. In comparison, the original septoplasty study by Stewart et al 1 demonstrated a 31- to 37-point change in NOSE score with septoplasty alone. This is less than the 43- to 50-point reductions that we observed in our study. While this may be due to the effect of addressing the nasal valve, any defini- tive conclusion is prevented by the heterogeneity within the included studies and between these studies and the study by Stewart et al. 1 Interestingly, the SMDs for the first 12 months were con- sistent with large clinical change (SMD, 1.30-1.54), but at 12 months of follow-up, the observed change was moder- ate (SMD, 0.46), and the 95% CIs could not exclude a

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