The need for an objective measure in septorhinoplasty surgery: Are we any closer to finding an answer?

OBJECTIVES:
To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease specific quality of life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom specific nasal questionnaires following septorhinoplasty..
DESIGN:
To perform a prospective comparative analysis between NIPF and the validated disease specific quality of life questionnaire SNOT 22 and to determine if a correlation exists following septorhinoplasty surgery.
SETTING:
The Royal National Throat Nose and Ear Hospital, London.
PARTICIPANTS:
A total of 122 patients (78 males, 44 females; mean age 33.5 +/- 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery MAIN OUTCOME MEASURES: Pre and post-operative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality of life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scores (VAS: 0-10).
RESULTS:
The mean pre-operative NIPF was 88.2L/min, and the post-operative value was 101.6L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P<0.0001); the NOSE score from 14.1 to 6.6 (P<0.0001); and the VAS blockage score from 6.9 to 3.2 (P<0.0001). All individual domains assessed showed improvements post-operatively but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom specific NOSE questionnaire and the nasal blockage domain on the VAS scale.
CONCLUSION:
We have demonstrated that NIPF does not correlate with the SNOT 22 disease specific questionnaire, although both outcomes significantly improve post-operatively. At present we are still lacking a clinically accurate objective measure of nasal function for the evaluation of patients undergoing septorhinoplasty surgery.