Objective evidence for the efficacy of surgical management of the deviated nasal septum as a treatment for chronic nasal obstruction

Background: Nasal septal surgery is a common procedure but there are concerns that the benefits of this surgery are mainly cosmetic. \n \nObjective of review: The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow. \n \nType of review: Systematic review. Search strategy: A systematic search of the available literature was performed, using Pubmed, Medline (1950-Dec 2013), Embase (1947-Nov 2010), and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre- and post-surgical treatment of nasal obstruction in adults due to septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry, and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection, and septal (deviation) corrective surgery. \n \nResults: Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry, and one study (22 participants) using nasal peak inspiratory flow, were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from 6 studies) decreased from pre-operative 1.19 Pa/cm3/s to post-operative 0.39 Pa/cm3/s, mean minimum cross sectional area (data from 5 studies) increased from pre-operative 0.45 cm2 to post-operative 0.61 cm2, median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery. \n \nConclusions: There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency, and that improved nasal airflow may have beneficial effects for the patient.