Prospective study on the functional outcome of septoplasty


  • Kulina A. Varghese Department of Ear Nose and Throat, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
  • Benjamin Alex Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India



Peak nasal inspiratory flow, SNOT-22, NOSE questionnaire, Septoplasty


Background: A thorough assessment of nasal obstruction remains a matter of debate with no accepted subjective and objective measurement tools. The purpose of this study was to use a cost-effective tool for objective assessment of nasal obstruction and compare it with subjective scores.

Methods: This was a longitudinal, prospective study conducted at a tertiary care center on patients undergoing septoplasty for deviated nasal septum (DNS) from March 2016 to August 2017. All patients were assessed pre- and post-operatively at 3 months with nasal peak inspiratory flow, sino-nasal outcome test (SNOT-22) and nasal obstruction symptom evaluation (NOSE) questionnaire to determine post-operative improvement and correlation between objective and subjective scores.  

Results: 64 patients were included in the study with 16 females and 48 males. Male patients had higher peak nasal inspiratory flow (PNIF) score post-operatively. Younger patients (less than 25 years) showed significant subjective improvement compared to older patients post-operatively using NOSE questionnaire. Significant improvement in PNIF, SNOT-22 and NOSE scores post-operatively using paired student-t test. There was moderate correlation between PNIF values and subjective scores before surgery and excellent correlation between the subjective SNOT-22 and NOSE scores before and after surgery.

Conclusions: PNIF is a cheap, portable, and convenient method for assessing nasal patency. Subjective and objective scores have good correlation, with improvement in all scores post-surgery. Men may show more objective improvement and early intervention at younger age may provide more subjective improvement.


Udaka T, Suzuki H, Fujimura T, Hiraki N, Ohkubo J, Shiomori T, et al. Chronic nasal obstruction causes daytime sleepiness and decreased quality of life even in the absence of snoring. Am J Rhinol. 2007;21:564-9.

Rhee JS, Book DT, Burzynski M, Smith TL. Quality of life assessment in nasal airway obstruction. Laryngoscope. 2003;113:11181122.

Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin North Am. 2009;42:207-25.

Nurse LA, Duncavage JA. Surgery of the inferior and middle turbinates. Otolaryngol Clin North Am. 2009;42:295-309.

Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130:157-63.

Eccles R. Nasal airway resistance and nasal sensation of airflow. Rhinol Suppl. 1992;14:86-90.

Sipila J, Suonpa JT, Kortekangas AE, Laippala PT. Rhinomanometry before septoplasty: An approach to clinical material with diverse nasal symptoms. Am J Rhinol. 1992;6:17-22.

Lenders H, Scholl R, Brunner M. Akustischerhinometrie: Das fledermausprinzip in der nase. HNO. 1992;40:239-47.

Kimbell JS, Garcia GJ, Frank DO, Cannon DE, Pawar SS, Rhee JS. Computed nasal resistance compared with patient-reported symptoms in surgically treated nasal airway passages: A preliminary report. Am J Rhinol Allergy. 2012;26:e94-8.

Andrè RF, Vuyk HD, Ahmed A, Graamans K, NolstTrenité GJ. Correlation between subjective and objective evaluation of the nasal airways. A systematic review of the highest level of evidence. Clin Otolaryngol. 2009;34(6):518-25.

Stewart MG, Witsell DL, Smith L, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130(2):157-63.

Pirila T, Tikanto J. Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry and subjective assessment. Am J Rhinol. 2001;15(2):127-33.

Marais J, Murray JA, Marshall I, Douglas N, Martin S. Minimal cross-sectional areas, nasal peak flow and patients’ satisfaction in septoplasty and inferior turbinectomy. Rhinology. 1994;32:145-7.

Hsu HC, Tan CD, Chang CW, Chu CW, Chiu YC, Pan CJ, et al. Evaluation of nasal patency by VAS/NOSE questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study. Clin Otolaryngol. 2016;42(1):53-9.

Menger DJ, Swart KM, Nolst Trenité GJ, Georgalas C, Grolman W. Surgery of the external nasal valve: the correlation between subjective and objective measurements. Clin Otolaryngol. 2014;39(3):150-5.






Original Research Articles