Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction: Analysis of Frequency, Preoperative Complaints and Benefit from Surgery.

[INTRODUCTION] Modern rhinoplasty has an aesthetic and a functional component that cannot be separated. Functional rhinoplasty generally concentrates on optimizing nasal airflow. Numerous techniques have been described for correction of each pathology. There seems to be a consensus on the benefit of surgery to patients with nasal obstruction. Present study aimed to determine if specific airway pathologies have differential effects on patient complaints and techniques addressing them have differential effects on perceived benefit from surgery.

[PATIENTS/METHOD] The records of 300 patients complaining nasal obstruction and had computerized tomography (CT) between April 2015 and April 2018 were retrospectively reviewed. Based on surgical notes, surgical techniques used for each patient were recorded. A survey using Nasal Obstruction Symptom Evaluation (NOSE) scale is done by phone. After descriptive statistics, preoperative complaint-diagnosed pathology, and postoperative relief-treated pathology relationships were evaluated.

[RESULTS] Preoperative and postoperative NOSE scores showed statistically significant difference (P <0.001). The CT analysis showed that septal deviation rate among patients complaining nasal obstruction is 85%, internal valve insufficiency rate is 34.4%, mild and severe inferior turbinate hypertrophy was 71% and 6%, respectively. Bullous and total concha bullosa of middle turbinate was 17.3%. Nearly 90% of patients had 2 or more types of pathology in CT analysis. Preoperative and postoperative NOSE scores showed no statistically significant relationship with singular intranasal pathologies and techniques used for correcting them, respectively.

[CONCLUSION] Despite general fall in NOSE scores in the whole study group, treatment of a specific pathology does not change NOSE score more than a patient who already does not have the pathology. None of the pathologies or treatments addressing them have a dominating effect on preoperative complaints or obtained relief after the surgery. So, success of functional rhinoplasty cannot rely on correction of a specific pathology. A comprehensive analysis and correction of every pathology is paramount.