A tool in the septoplasty decision making process

Subjective nasal obstruction is a common chronic complaint caused by mucosal disease, skeletal abnormality or a combination of both. The challenge is to determine the main cause and to decide whether the intervention should be medical or surgical. Diagnosis is done by a combination of rhinoscopy, subjective and objective assessments of nasal obstruction. Rhinomanometry measures the nasal airway resistance (NAR) for each nasal cavity. Septal deviations are common with prevalences of up to 58% with the majority having no nasal complaints. Septoplasty can straighten the septum. In Sweden on average 24% of patients are dissatisfied 6 months after their septoplasty. The principal aim of this thesis was to investigate the clinical use of rhinomanometry in the septoplasty decision making process. This resulted in a checklist to increase the patients’ satisfaction with the operation. We found that higher age and allergic rhinitis were factors giving significant odds for a spontaneous long term improvement of the nasal obstruction without septoplasty. That was in spite of septal deviation and pathological NAR. In a study of 1000 patients with nasal obstruction we found that there has to be a certain NAR side difference between the nasal cavities before the patient could significantly assess it on a Visual Analogue Scale. When rhinomanometry was performed in 9 participants every two weeks during 5 months, we found a high variability of the NAR, where tested subjects could move from pathological to normal. Intervention with topical budesonide treatment during a new five month period reduced both NAR and it’s variability significantly.