ABSTRACT
Abstract Introduction: Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. Objective: To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical-epidemiological variables associated with functional outcome. Methods: Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical-epidemiological variables with the scores obtained. Results: Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann-Whitney). Conclusion: Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.
Resumo Introdução: Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento. Objetivo: Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional. Método: Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos. Resultados: Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney). Conclusão: A septoplastia e a fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Turbinates/surgery , Nasal Obstruction/surgery , Nasal Obstruction/psychology , Nose Deformities, Acquired/surgery , Nose Deformities, Acquired/psychology , Nasal Septum/surgery , Postoperative Period , Chronic Disease , Prospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Abstract Introduction Diode laser is a new alternative in stapes surgery for otosclerosis. The present study is the first to compare the short-term results of the surgery performed using diode laser to those obtained through the conventional fenestration technique. Objective To use audiometry to establish a comparative analysis between the functional results obtained through surgery for otosclerosis using diode laser and the conventional technique. Method Audiometric evaluation of 12 patients submitted to stapes surgery for otosclerosis, using diode laser or conventional fenestration by needle and drills, between 2014 and 2015. Each group was composed of 6 patients. Pre and postoperative measures were compared for three months in both groups. The speech recognition threshold, the air and bone conduction threshold, as well as the gap between them at 500 Hz, 1 KHz, 2 KHz and 4 KHz were measured. Results Significant difference in bone conduction and SRT was observed when compared post- and preoperative results in the diode group. However diode and conventional technique groups presented significant differences in air conduction and air-bone gap, suggesting that both can provide functional improvement. Conclusion Laser stapedotomy is a safe technique with good results. Both laser surgery and the conventional technique have improved the hearing of patients with a discreet advantage for the diode laser. Further prospective and randomized clinical trials are required to disclose all possible benefits of the stapes surgery using diode laser.