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Facial Plast Surg 2020; 36(01): 066-071
DOI: 10.1055/s-0040-1701488
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functionally Crippled Nose

Priyesh Patel
1   Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
,
Sam P. Most
1   Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
› Author Affiliations
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Publication History

Publication Date:
19 March 2020 (online)

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Abstract

Nasal obstruction is a common presenting symptom of patients seen by primary care physicians, otolaryngologists, and facial plastic surgeons. A variety of treatment strategies, both surgical and nonsurgical, have been used with success in improving nasal obstruction and quality of life. In a subset of patients, many of whom have either attempted these common treatment strategies or are intolerant of them, nasal obstruction remains a significant symptom. In these patients, there may be an identifiable problem, but it is simply not repairable or there is no identifiable anatomic issue. The management of these patients is discussed in this article, with an emphasis on a sensitive approach that takes into consideration a patient's mental health. While the need for diagnostic testing is generally not necessary for most cases of nasal obstruction, endoscopy and imaging should be considered in these patients. Validated patient-reported outcome measures are particularly helpful in providing an objective measure to a patient's frustrating symptoms. A variety of medications can be either contributory to the patient's symptoms or therapeutic if used appropriately. A variety of surgical interventions can also result in a functionally crippled nose and diagnoses including nasal valve stenosis, septal perforations, and empty nose syndrome are discussed. Importantly, further surgical interventions may not be appropriate if a deformity is minimal, and a surgeon should resist the temptation to proceed with surgery in those situations.

Keywords

nasal obstruction - congestion - nasal valve - rhinoplasty
 

  • References

  • 1 Jessen M, Malm L. Definition, prevalence and development of nasal obstruction. Allergy 1997; 52 (40, Suppl): 3-6
    CrossrefPubMedGoogle Scholar
  • 2 Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med 2005; 4 (06) 439-446
    CrossrefPubMedGoogle Scholar
  • 3 Udaka T, Suzuki H, Fujimura 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 (05) 564-569
    CrossrefPubMedGoogle Scholar
  • 4 Stewart M, Ferguson B, Fromer L. Epidemiology and burden of nasal congestion. Int J Gen Med 2010; 3: 37-45
    PubMedGoogle Scholar
  • 5 Phillips KM, Hoehle LP, Bergmark RW. , et al. Association between nasal obstruction and risk of depression in chronic rhinosinusitis. Otolaryngol Head Neck Surg 2017; 157 (01) 150-155
    CrossrefPubMedGoogle Scholar
  • 6 Yamasaki A, Levesque PA, Bleier BS. , et al. Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery. Laryngoscope 2019; 129 (07) 1554-1560
    CrossrefPubMedGoogle Scholar
  • 7 Kahraman E, Cil Y, Incesulu A. The effect of nasal obstruction after different nasal surgeries using acoustic rhinometry and nasal obstruction symptom evaluation scale. World J Plast Surg 2016; 5 (03) 236-243
    PubMedGoogle Scholar
  • 8 Fuller JC, Levesque PA, Lindsay RW. Assessment of the EuroQol 5-dimension questionnaire for detection of clinically significant global health-related quality-of-life improvement following functional septorhinoplasty. JAMA Facial Plast Surg 2017; 19 (02) 95-100
    CrossrefPubMedGoogle Scholar
  • 9 Fraser L, Kelly G. An evidence-based approach to the management of the adult with nasal obstruction. Clin Otolaryngol 2009; 34 (02) 151-155
    CrossrefPubMedGoogle Scholar
  • 10 Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence) 2013; 4 (02) e66-e68
    PubMedGoogle Scholar
  • 11 Mohan S, Fuller JC, Ford SF, Lindsay RW. Diagnostic and therapeutic management of nasal airway obstruction: advances in diagnosis and treatment. JAMA Facial Plast Surg 2018; 20 (05) 409-418
    CrossrefPubMedGoogle Scholar
  • 12 Hamdan AL, Sabra O, Hadi U. Prevalence of adenoid hypertrophy in adults with nasal obstruction. J Otolaryngol Head Neck Surg 2008; 37 (04) 469-473
    PubMedGoogle Scholar
  • 13 Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin North Am 2009; 42 (02) 207-225 , vii
    CrossrefPubMedGoogle Scholar
  • 14 Kjaergaard T, Cvancarova M, Steinsvåg SK. Does nasal obstruction mean that the nose is obstructed?. Laryngoscope 2008; 118 (08) 1476-1481
    CrossrefPubMedGoogle Scholar
  • 15 Stewart MG, Smith TL, Weaver EM. , et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004; 130 (03) 283-290
    CrossrefPubMedGoogle Scholar
  • 16 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 17 Benninger M. Diagnosis and management of nasal congestion: the role of intranasal corticosteroids. Postgrad Med 2009; 121 (01) 122-131
    CrossrefPubMedGoogle Scholar
  • 18 Bridgeman MB. Overcoming barriers to intranasal corticosteroid use in patients with uncontrolled allergic rhinitis. Integr Pharm Res Pract 2017; 6: 109-119
    PubMedGoogle Scholar
  • 19 Mahadevia PJ, Shah S, Leibman C, Kleinman L, O'Dowd L. Patient preferences for sensory attributes of intranasal corticosteroids and willingness to adhere to prescribed therapy for allergic rhinitis: a conjoint analysis. Ann Allergy Asthma Immunol 2004; 93 (04) 345-350
    CrossrefPubMedGoogle Scholar
  • 20 Cingi C, Ozdoganoglu T, Songu M. Nasal obstruction as a drug side effect. Ther Adv Respir Dis 2011; 5 (03) 175-182
    CrossrefPubMedGoogle Scholar
  • 21 Graf PM. Rhinitis medicamentosa. Clin Allergy Immunol 2007; 19: 295-304
    PubMedGoogle Scholar
  • 22 Rozner L, Isaacs GW. Nasal obstruction after rhinoplasty. Aesthetic Plast Surg 1979; 3 (01) 89-96
    CrossrefPubMedGoogle Scholar
  • 23 Okland TS, Kandathil C, Sanan A, Rudy S, Most SP. Analysis of nasal obstruction patterns following reductive rhinoplasty. Aesthetic Plast Surg 2019
    PubMedGoogle Scholar
  • 24 Beekhuis GJ. Nasal obstruction after rhinoplasty: etiology, and techniques for correction. Laryngoscope 1976; 86 (04) 540-548
    CrossrefPubMedGoogle Scholar
  • 25 Joe SA. The assessment and treatment of nasal obstruction after rhinoplasty. Facial Plast Surg Clin North Am 2004; 12 (04) 451-458 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 26 Surowitz J, Lee MK, Most SP. Anterior septal reconstruction for treatment of severe caudal septal deviation: clinical severity and outcomes. Otolaryngol Head Neck Surg 2015; 153 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 27 Most SP. Anterior septal reconstruction: outcomes after a modified extracorporeal septoplasty technique. Arch Facial Plast Surg 2006; 8 (03) 202-207
    CrossrefPubMedGoogle Scholar
  • 28 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952 , discussion 953–955
    CrossrefPubMedGoogle Scholar
  • 29 Sawh-Martinez R, Perkins K, Madari S, Steinbacher DM. Control of nasal tip position: quantitative assessment of columellar strut versus caudal septal extension graft. Plast Reconstr Surg 2019; 144 (05) 772e-780e
    CrossrefPubMedGoogle Scholar
  • 30 Kridel RWH, Delaney SW. Simultaneous septal perforation repair with septorhinoplasty: a 31-year experience. Facial Plast Surg 2018; 34 (03) 298-311
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Kridel RWH, Delaney SW. Approach to correction of septal perforation. Facial Plast Surg Clin North Am 2019; 27 (04) 443-449
    CrossrefPubMedGoogle Scholar
  • 32 Nuñez-Fernández D, Vokurka J, Chrobok V. Bone and temporal fascia graft for the closure of septal perforation. J Laryngol Otol 1998; 112 (12) 1167-1171
    CrossrefPubMedGoogle Scholar
  • 33 Ribeiro JS, da Silva GS. Technical advances in the correction of septal perforation associated with closed rhinoplasty. Arch Facial Plast Surg 2007; 9 (05) 321-327
    PubMedGoogle Scholar
  • 34 Pedroza F, Patrocinio LG, Arevalo O. A review of 25-year experience of nasal septal perforation repair. Arch Facial Plast Surg 2007; 9 (01) 12-18
    CrossrefPubMedGoogle Scholar
  • 35 Morse J, Harris J, Owen S, Sowder J, Stephan S. Outcomes of nasal septal perforation repair using combined temporoparietal fascia graft and polydioxanone plate construct. JAMA Facial Plast Surg 2019; 21 (04) 319-326
    CrossrefPubMedGoogle Scholar
  • 36 Kim SW, Rhee CS. Nasal septal perforation repair: predictive factors and systematic review of the literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (01) 58-65
    CrossrefPubMedGoogle Scholar
  • 37 Gill AS, Said M, Tollefson TT, Steele TO. Update on empty nose syndrome: disease mechanisms, diagnostic tools, and treatment strategies. Curr Opin Otolaryngol Head Neck Surg 2019; 27 (04) 237-242
    CrossrefPubMedGoogle Scholar
  • 38 Payne SC. Empty nose syndrome: what are we really talking about?. Otolaryngol Clin North Am 2009; 42 (02) 331-337 , ix–x
    CrossrefPubMedGoogle Scholar
  • 39 Velasquez N, Thamboo A, Habib AR, Huang Z, Nayak JV. The Empty Nose Syndrome 6-Item Questionnaire (ENS6Q): a validated 6-item questionnaire as a diagnostic aid for empty nose syndrome patients. Int Forum Allergy Rhinol 2017; 7 (01) 64-71
    CrossrefPubMedGoogle Scholar
  • 40 Thamboo A, Velasquez N, Habib AR, Zarabanda D, Paknezhad H, Nayak JV. Defining surgical criteria for empty nose syndrome: validation of the office-based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6-Item Questionnaire. Laryngoscope 2017; 127 (08) 1746-1752
    CrossrefPubMedGoogle Scholar
  • 41 Manji J, Nayak JV, Thamboo A. The functional and psychological burden of empty nose syndrome. Int Forum Allergy Rhinol 2018; 8 (06) 707-712
    CrossrefPubMedGoogle Scholar
  • 42 Burgos MA, Sevilla García MA, Sanmiguel Rojas E. , et al. Virtual surgery for patients with nasal obstruction: use of computational fluid dynamics (MeComLand®, Digbody® & Noseland®) to document objective flow parameters and optimise surgical results. Acta Otorrinolaringol Esp 2018; 69 (03) 125-133
    CrossrefPubMedGoogle Scholar
  • 43 Bailey RS, Casey KP, Pawar SS, Garcia GJ. Correlation of nasal mucosal temperature with subjective nasal patency in healthy individuals. JAMA Facial Plast Surg 2017; 19 (01) 46-52
    CrossrefPubMedGoogle Scholar