‘Valve-stabilised’ rhinospirometry can predict the benefit of septal surgery: a pre- and post-operative correlation study

Septoplasty is a procedure often associated with high levels of patient dissatisfaction post-operatively. This study examined whether rhinospirometry and a modified ‘valve-stabilised’ technique could pre-operatively predict the outcome of septal surgery and therefore have a role as an objective tool for selection of patients suffering from nasal obstruction due to septal deformity for the procedure of septoplasty. A prospective study was performed of patients attending Singleton Hospital, Swansea, for surgical treatment of nasal obstruction due to septal deformity. Participants were asked to undertake decongested visual analogue scoring (VAS) and rhinospirometric assessment of their nasal obstruction in both normal ‘resting’ and ‘valve-stabilised’ nasal positioning. These investigations were undertaken on the day of surgery and 6 weeks post-operatively. Results were converted into nasal partition ratio scores and were assessed statistically for difference, correlation and accuracy. A total of 29 individual participants were included in the study. Septal surgery produced a statistically significant improvement in nasal airflow symmetry in the normal ‘resting’ nasal position using rhinospirometry (Wilcoxon ranked p[0.5). This difference was not seen between evaluations in ‘valve-stabilised’ position (Wilcoxon p\0.001). No statistical difference was evident between pre-operative ‘valve-stabilised’ testing and post-operative ‘resting position’. The finding was also apparent on VAS nasal assessment. Correlation studies showed a strong relationship between pre-operative ‘valve-stabilised’ and postoperative ‘resting’ rhinospirometry results (Spearman’s rho = 0. 586, p\0.002). The strength of this relationship between VAS assessments was less pronounced (Spearman’s rho = 0.386 p = 0.07). ‘Valve-stabilised’ rhinospirometry and VAS appear to be useful pre-operatively to predict the outcome of septal surgery, in terms of airflow symmetry, for nasal obstruction due to septal deformity, with pre-operative ‘valve-stabilised’ results correlating well with the post-operative standard ‘resting’ outcomes. Valve-stabilised rhinospirometry may have a role in preoperatively predicting of likely post-operative patient satisfaction, although further studies are required in this area.