22 Quality of Life

10.1055/b-0037-145041

22 Quality of Life

Fabio Ferreli, Paolo Castelnuovo

Summary

The three-layer nasoseptal defect is a relatively rare condition, with a prevalence rate of 0.9%. ¹ ^, ² Nasal septal perforations (NSPs) give rise to not only disintegration of the septum anatomy but also impairment in normal nasal physiology. ³ Anatomical and physiologic changes following perforation lead to many different symptoms, such as sensation of nasal obstruction, crusting, epistaxis, dryness, rhinorrhea, snoring and whistling sounds, cacosmia, and headaches. ⁴ If these symptoms persist despite specific medical nasal care, a surgical NSP closure, if technically possible, is desirable.

For the success of a standard surgical procedure but not only technical, positive changes in quality of life should be taken into consideration. Often, the success of these surgical techniques is usually equated to anatomical closure of the perforation, while aspects related to the quality of life are not always investigated. Surgical approaches should aim to solve both the anatomical and physiologic problems of NSP. It is important to quantify surgical outcomes with objective and subjective tests and compare them with preoperative findings. Especially after rhinologic surgeries (septoplasty, rhinoplasty, conchal surgery, etc.), there can be a divergence between the objective and subjective findings. ⁵

22.1 Objective Assessment

Even though relief in subjective symptoms of patients is important, an objective measurement of nasal physiology should be performed. Applying an objective assessment of pre- and postoperative nasal septal and nasal cavity physiology provides an opportunity to compare the physiologic results of various surgical procedures and can lead to the identification of the ideal method. Rhinomanometry (RMM) tests nasal airway resistance by measuring nasal airflow and the pressure produced by nasal airflow. ⁶ RMM has been used for the evaluation of various nasal surgical techniques. ⁷ Studies based on computational fluid dynamic simulations were able to show airflow patterns, temperature, and humidity distribution in nose models of healthy noses. In nose models with septal perforation, several pathological conditions could be shown. Disturbed airflow patterns mainly in the area of the posterior margin of the septal perforation are responsible for the crusting in this region. Huge vortices cause subjective nasal obstruction in patients with septal perforation. NSPs are frequently located in the anterior caudal cartilaginous part of the septum after previous surgery and cause more symptoms than the NSPs, which are located more in the cranial or more in the posterior portion. ⁸

In fact, most of the symptomatic NSPs are in the anterior portion of the septum, whereas posterior septal defects can be asymptomatic. Knowledge regarding the temperature and humidity profile within septal perforation is scarce. Lindemann et al performed two in vivo studies to investigate these parameters comparing healthy volunteers and patients with NSP as well as before and after surgical closure of NSP. They observed a significantly reduced increase in humidity in patients with NSP compared to the healthy volunteers. The patients with NSP suffered significantly more from nasal dryness. Postoperatively, the increase in temperature and humidity was significantly higher than preoperatively. ⁹

Olfaction has an important role in the human interaction with the environment, and changes in olfaction abilities due to NSP can lead to a significant decrease in quality of life. The surgical repair of nasal septal perforation is known to improve nasal respiratory airflow, which seems to be beneficial to the patient’s olfactory abilities. However, there are only limited data on the effect of nasal septal perforation closure on olfaction, and most studies reported contradictory results. ¹⁰ ^, ¹¹ ^, ¹² In a recent study, Altun and Hanci reported a statistically significant improvement in olfactory function determined by using the Sniffin’ Sticks on the short- and long-term olfactory abilities of 42 patients with NSP after surgical repair. ¹³