The systolic pulmonary artery pressure and the E/e' ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation.

INTRODUCTION: Nasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases. OBJECTIVE: To investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty. METHODS: The prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients. RESULTS: Mean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e' ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e' ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05). CONCLUSION: The decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e's ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.

Does septoplasty affect 24-h ambulatory blood pressure measurements in patients with type 2 and 3 pure nasal septal deviation?

PURPOSE: To investigate day, night and 24 h all blood pressure effects of septoplasty by comparing pre- and post-operative 24-h ambulatory blood pressure monitoring (ABPM) values of NSD patients undergoing septoplasty. MATERIALS AND METHODS: The prospective study included 20 patients with type 2 and 3 pure NSD (mean age, 23.60 ± 6.51) who underwent septoplasty in our clinic. Nasal obstruction symptom evaluation (NOSE) questionnaire was applied to each participant both pre- and post-operatively to evaluate their views on the severity of NSD and the effectiveness of surgical outcomes. A comprehensive ABPM examination was performed both 2 days before surgery and at three months postoperatively for each patient and the findings were compared among patients. RESULTS: Preoperative NOSE score was 87.75 ± 7.34% and the postoperative score was 12.50 ± 6.58% (p = 0.000). Following septoplasty, 24-h systolic blood pressure (24SBP) declined from 119.4 ± 9.9 mmHg to 112.2 ± 8.0 mmHg (p = 0.000), daytime SBP (DSBP) declined from 125.9 ± 11.0 mmHg to 117.9 ± 8.4 mmHg (p = 0.000), nighttime SBP (NSBP) declined from 112.7 ± 9.5 mmHg to 105.5 ± 7.9 mmHg (p = 0.000), 24-h pulse pressure (24PP) declined from 46.7 ± 10.1 mmHg to 44.0 ± 8.4 mmHg (p = 0.015), and mean daytime PP (DPP) declined from 46.9 ± 9.7 mmHg to 44.6 ± 8.6 mmHg (p = 0.026). CONCLUSION: The decline in NOSE percentages following septoplasty demonstrated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to NSD may affect ABPM measurements. Moreover, the significant decrease in the 24SBP, DSBP, NSBP, 24PP and DPP following septoplasty showed that NSD may cause cardiovascular risk and this risk may be prevented by septoplasty.