Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework.

OBJECTIVE: Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies. STUDY DESIGN: A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations. SETTING: An online questionnaire was distributed in July 2023. METHODS: The questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W-NASs) to represent the perceived importance of each feature, scaled from 0 to 1. RESULTS: General concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W-NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W-NAS, 0.67). Similar analyses were performed for features in each case. CONCLUSION: The implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision-making during nasal endoscopy.

"Does My Kid Have an Ear Infection?" An Analysis of Pediatric Acute Otitis Media Videos on TikTok.

INTRODUCTION: With the rise of social media, online platforms have become a common way to access healthcare information. This study examines the quality of pediatric acute otitis media (AOM) videos on TikTok, a popular short-form video social media platform. METHODS: A TikTok search was conducted between 8/18 and 8/19/2023 using pediatric AOM hashtags: #pediatric acute otitis media management, #kid ear infections remedy, #child ear infections treatment, and #kid ear infection. Data collected include number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional), and content categories. The Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-AV) and DISCERN questionnaire measured understandability, actionability, and quality of videos. Multivariable linear regression models were used (significance set at ≤0.05). RESULTS: Of 166 videos, 38.6% (64) of uploaders were medical professionals, and 32.5% (54) were nonmedical influencers. Nonmedical influencer videos were viewed and shared significantly more than those by medical professionals (p < 0.05). Controlling for covariates, physicians were more likely to produce more beneficial and higher quality videos as compared with nonmedical influencers (ß = 2.4 and 1.3, p < 0.01, respectively). However, physicians did not have significantly different ratings for understandability compared with nonmedical influencers (ß = 0.45, p > 0.05). DISCUSSION: AOM content on TikTok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

A Social Media Quality Review of Popular Sinusitis Videos on TikTok.

OBJECTIVE: Social media may inform health care decisions among younger patient populations. TikTok is a social media platform that allows users to post short-form videos. This study aimed to assess the quality of sinusitis-related videos on TikTok. STUDY DESIGN: We searched TikTok on January 29, 2023, for sinusitis-related hashtags: #sinusitis, #sinus, #sinusinfection. SETTING: Internet. METHODS: The number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional) content categories (medical advice, marketing, comedy, and lifestyle/acceptability), and content type (educational vs factual) were collected. The Patient Education Materials Assessment Tool for Audiovisual Material and Journal of the American Medical Association criteria score was used to measure understandability, actionability, and reliability. The Global Quality Scale (GQS) was used to evaluate the quality of videos; the harm/benefit score was used to evaluate causative effects. Analyses were performed using analysis of variance (α = .05). RESULTS: There were 221 videos identified, which garnered over 300 million views and 1 million shares. Almost half of the videos were published by nonmedical influencers. When controlling for covariates, nonmedical influencers and lay uploaders were more likely to have harmful harm/benefit scores, less understandable videos, and lower GQS scores compared to medical professionals. Less than half of videos posted by nonmedical influencers categorized as educational were factual (46.7%); lay individuals and medical professionals had higher rates of factual educational content (79.9% and 83.7%, respectively). CONCLUSION: Most nonmedical influencer-posted TikTok videos about sinusitis are inaccurate, despite being portrayed as medical advice/educational. Rhinologists must find modern ways to disseminate true disease-related content via social media to combat medical misinformation.

The Time Burden of Office Visits in Contemporary Pituitary Care, 2016 to 2019.

BACKGROUND: The concept of "time toxicity" has emerged to address the impact of time spent in the healthcare system; however, little work has examined the phenomenon in the field of otolaryngology. OBJECTIVE: To validate the use of Evaluation and Management (E/M) current procedural terminology codes as a method to assess time burden and to pilot this tool to characterize the time toxicity of office visits associated with a diagnosis of pituitary adenoma between 2016 and 2019. METHODS: A retrospective cohort study of outpatient office visits quantified differences between timestamps documenting visit length and their associated E/M code visit length. The IBM MarketScan database was queried to identify patients with a diagnosis of pituitary adenoma in 2016 and to analyze their new and return claims between 2016 and 2019. One-way ANOVA and two-sample t-tests were used to examine claim quantity, time in office, and yearly visit time. RESULTS: In the validation study, estimated visit time via E/M codes and actual visit time were statistically different (P < 0.01), with E/M codes underestimating actual time spent in 79.0% of visits. In the MarketScan analysis, in 2016, 2099 patients received a primary diagnosis of pituitary adenoma. There were 8490 additional-related claims for this cohort from 2016 to 2019. The plurality of new office visits were with endocrinologists (n = 857; 29.3%). Total time spent in office decreased yearly, from a mean of 113 min (2016) to 69 min (2019) (P < 0.001). CONCLUSIONS: E/M codes underestimate the length of outpatient visits; therefore, time toxicity experienced by pituitary patients may be greater than reported. Further studies are needed to develop additional assessment tools for time toxicity and promote increased efficiency of care for patients with pituitary adenomas.

Impact of social determinants of health on access to rhinology care and patient outcomes: A pilot study.

Objective: This novel pilot study constructs a social deprivation index (SDI) and utilizes an area deprivation index (ADI) to evaluate the link between social determinants of health and rhinology patient experiences. Methods: Adult patients undergoing outpatient care of chronic rhinitis and chronic rhinosinusitis at a tertiary academic medical center were recruited to participate in a telephone survey assessing symptoms, social/emotional consequences of disease, and barriers to care on a 5-point Likert scale. Sociodemographic characteristics were utilized to rate SDI on an 8-point scale. ADI was obtained by area code of residence. Ordered logistic regression was used to examine associations between the SDI/ADI and perceptions of rhinology care. Results: Fifty patients were included. Individuals with higher SDI scores (i.e., more socially deprived) experienced more severe nasal congestion (p = .007). Furthermore, higher national ADI correlated with increased severity of smell changes (p = .050) and facial pressure (p = .067). No association was seen between either deprivation index and global/psychiatric symptoms. While no correlations were found between higher SDI and difficulties with the costs of prescriptions, rhinologist's visits, or saline, higher SDI was correlated with decreased difficulty with surgery costs (p = .029), and individuals with higher national ADI percentile had increased difficulties obtaining nasal saline (p = .029). Conclusion: Worse social deprivation is associated with difficulties obtaining saline rinses and increased severity of nasal/sinus symptoms in an urban, underserved, majority-Black population. These findings suggest social factors affect access to and quality of rhinology care in a complex and nuanced way and highlight the need for a specific SDI to further study social determinants of health in rhinology. Level of Evidence: 2c.

Are rhinitis and Eustachian tube dysfunction associated in United States adolescents?

OBJECTIVES: Despite longstanding clinical gestalt of a relationship between rhinitis and Eustachian tube dysfunction (ETD), population-level evidence supporting this connection is lacking, particularly among adolescents. We aimed to investigate the association between rhinitis and ETD in a nationally-representative sample of United States adolescents. METHODS: We performed cross-sectional analyses of 2005-2006 National Health and Nutrition Examination Survey data (n = 1955, ages 12-19). Rhinitis (self-reported hay fever and/or nasal symptoms in the past 12 months) was stratified as allergic (AR) or nonallergic rhinitis (NAR) based on serum IgE aeroallergen positivity. History of ear disease and procedures was recorded. Tympanometry was classified by type (A, B, C). Multivariable logistic regression was used to test the association of rhinitis and ETD. RESULTS: Among US adolescents, 29.4% reported rhinitis (NAR 38.9%, AR 61.1%), and 14.0% had abnormal tympanometry. Adolescents with rhinitis were more likely to report a history of ≥3 ear infections (NAR: OR 2.40, 95% CI: 1.72-3.34, p < 0.001; AR: OR 1.89, 95% CI: 1.21-2.95, p = 0.008) and tympanostomy tube placement (NAR: OR 3.53, 95% CI: 2.07-6.03, p < 0.001; AR: OR 1.91, 95% CI: 1.24-2.94, p = 0.006), compared to those without rhinitis. There was no association between rhinitis and abnormal tympanometry (NAR: p = 0.357; AR: p = 0.625). CONCLUSION: NAR and AR are both associated with history of frequent ear infections and tympanostomy tube placement in US adolescents, supporting an association with ETD. This association is strongest for NAR, suggesting that specific inflammatory mechanisms may be involved in this condition and potentially explaining why traditional therapies for AR are largely ineffective for ETD.

Magnetic Resonance Imaging as a Diagnostic and Research Tool in Patients with Olfactory Dysfunction: A Systematic Review.

BACKGROUND: Patients with acquired, idiopathic olfactory dysfunction (OD) commonly undergo magnetic resonance imaging (MRI) evaluation to rule out intracranial pathologies. This practice is highly debated given the expense of MRI relative to the probability of detecting a treatable lesion. This, combined with the increasing use of MRI in research to investigate the mechanisms underlying OD, provided the impetus for this comprehensive review. OBJECTIVE: The purpose of this systematic review was to both assess the utility of MRI in diagnosis of idiopathic OD and to describe MRI findings among mixed OD etiologies to better understand its role as a research tool in this patient population. METHODS: A literature search of PubMed, Embase, Cochrane, Web of Science, and Scopus for studies with original MRI data for patients with OD was completed. Studies exclusively investigating patients with neurocognitive deficits or those studying traumatic or congenital etiologies of OD were excluded. RESULTS: From 1758 candidate articles, 33 studies were included. Four studies reviewed patients with idiopathic OD for structural pathologies on MRI, of which 17 of 372 (4.6%) patients had a potential central cause identified, and 3 (0.8%) had an olfactory meningioma or olfactory neuroblastoma. Fourteen studies (42.4%) reported significant correlation between olfactory bulb volume and olfactory outcomes, and 6 studies (18.8%) reported gray matter volume reduction, specifically in the orbitofrontal cortex, anterior cingulate cortex, insular cortex, parahippocampal, and piriform cortex areas, in patients with mixed OD etiologies. Functional MRI studies reported reduced brain activation and functional connectivity in olfactory network areas. CONCLUSION: MRI uncommonly detects intracranial pathology in patients with idiopathic OD. Among patients with mixed OD etiologies, reduced olfactory bulb and gray matter volume are the most common abnormal findings on MRI. Further research is required to better understand the role of MRI and its cost-effectiveness in patients with acquired, idiopathic OD.

Magnetic Resonance Imaging Findings Among Individuals With Olfactory and Cognitive Impairment.

OBJECTIVES: The underlying mechanism of the association between olfactory impairment and dementia may be explained by neurodegenerative changes detected on magnetic resonance imaging (MRI). The purpose of this systematic review is to describe neurodegenerative changes on MRI in patients with olfactory impairment and mild cognitive impairment (MCI) or dementia. STUDY DESIGN: Systematic review. METHODS: A literature search encompassing PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar for studies with MRI and olfactory testing among participants diagnosed with MCI or dementia was performed. Sample size, study design, cognitive impairment type, olfactory testing, and MRI findings were abstracted. Two investigators independently reviewed all articles. RESULTS: The search yielded 556 nonduplicate abstracts, from which 86 articles were reviewed and 24 were included. Seventeen (71%) of 24 studies reported hippocampal volume findings, with 14 studies reporting a relationship between hippocampal volume and olfactory performance. Two (50%) of four prospective studies reported the potential utility of baseline hippocampal volume as a marker of dementia conversion from MCI. Five (21%) of 24 studies reporting olfactory functional MRI (fMRI) findings highlighted the utility of olfactory fMRI to identify individuals in the early stages of cognitive decline. CONCLUSION: Current evidence suggests hippocampal volume correlates with olfactory performance in individuals with cognitive impairment, and that olfactory fMRI may improve early detection of AD. However, the predictive utility of these imaging markers is limited in prospective studies. MRI may be a useful modality for selecting patients at high risk of future cognitive decline for enrollment in early treatment trials. Laryngoscope, 132:177-187, 2022.

Association Between Chemosensory Dysfunction and Diet Quality in United States Adults.

BACKGROUND: Evidence suggests chemosensory dysfunction (CSD) patients have altered diet, but population-level evidence assessing diet quality in CSD patients is lacking. OBJECTIVE: We examined the association between CSD and diet quality in a representative sample of United States adults. METHODS: This cross-sectional study included 2831 adults aged greater than 40 years from the 2013-2014 National Health and Nutrition Examination Survey who completed the taste/smell questionnaire and examination. Mean nutrient intake in subjects with self-reported olfactory/gustatory dysfunction (sOD/sGD) and measured olfactory/gustatory dysfunction (mOD/mGD) were compared to those without CSD using univariate Wilcoxon rank-sum tests. The Healthy Eating Index (HEI), a validated measure of diet quality, was calculated. The proportion of subjects with CSD with bottom-quartile HEI was compared to those without CSD using multivariate logistic regression, adjusting for demographic and socioeconomic covariates. RESULTS: The population-weighted prevalence of sOD, sGD, mOD, and mGD was 20.1%, 14.4%, 15.9% and 25.6%, respectively. Subjects with mOD had lower mean intake of total calories, total fat, protein, sodium, and potassium compared to normal subjects (1873.4 ± 49.6 vs 2010.2 ± 24.2 kcal, 72.3 ± 2.7 vs 78.6 ± 1.0 gm, 74.0 ± 2.5 vs 80.4 ± 0.6 gm, 3122 ± 97.2 vs 3353.2 ± 37.0 mg, 2509.8 ± 69.8 vs 2684.7 ± 26.1 mg, P < 0.05 respectively). When controlling for sociodemographic factors and comorbidities, subjects with sOD were more likely to have bottom-quartile HEI compared to normal subjects (OR 1.33, 95% CI 1.04-1.70). CONCLUSIONS: This population-level study suggests an association between poor diet quality and variation in dietary intake in patients with CSD, which warrants further investigation and suggests the possible need for nutritional counseling for CSD patients.

Management of the middle turbinate during and after sinus surgery.

PURPOSE OF REVIEW: Treatment of the middle turbinate (MT) during and after endoscopic sinus surgery (ESS) has been controversial. Historically, there has been concern that resection of the MT may result in smell loss and frontal sinus stenosis. However, these concerns must be balanced by knowledge that a residual diseased MT may result in surgical failure. This review discusses the current evidence on treatment of the MT during and after ESS. RECENT FINDINGS: Several review articles have shown the safety of performing MT resection. Studies have not shown increase rates of frontal sinus stenosis, olfactory loss, or empty nose syndrome. However, the benefit of MT resection is highly debated. There have also been many recent advances and technological developments to assist in management of the postoperative MT. SUMMARY: The literature supports the safety of performing MT resection, however, the benefit of resection over preservation is controversial. New technologies and techniques exist that may aid in preventing postoperative MT lateralization.

The association of frailty with olfactory and gustatory dysfunction in older adults: a nationally representative sample.

BACKGROUND: Olfaction and gustation are associated with age-related decline. Deficits in these chemosenses have been associated with significant comorbidities. Meanwhile, frailty, defined as a reduced physiological reserve, is well correlated with mortality and worse health outcomes. We sought to analyze a nationally representative patient population to determine the association between chemosensory dysfunction and frailty. METHODS: Cross-sectional analysis of U.S. National Health and Nutrition Examination Survey (NHANES) 2013-2014 was performed, using multivariate logistic regression to examine the association between chemosensory dysfunction and frailty in adults aged ≥40 years (n = 3547). Self-reported olfactory dysfunction (sOD) and gustatory dysfunction (sGD), and measured olfactory dysfunction (mOD) and gustatory dysfunction (mGD) were assessed for all participants. Frailty was operationalized using a 39-item frailty index (FI) and stratified into 4 groups using validated cutoffs. RESULTS: Participants with sOD and mOD had significantly higher mean FI scores (sOD: 0.18 vs 0.13, p < 0.001; mOD: 0.20 vs 0.14, p < 0.001), whereas subjects with sGD, but not mGD, had higher mean FI scores (sGD: 0.21 vs 0.13, p < 0.001; mGD: 0.14 vs 0.14, p = 0.953). Multivariate logistic regression demonstrated frail participants had significantly greater odds of sGD (odds ratio [OR] 4.11; 95% confidence interval [CI], 3.46 to 4.88), sOD (OR 2.35; 95% CI, 1.98 to 2.78), and mOD (OR 1.58; 95% CI, 1.22 to 2.05), but not mGD (OR 1.21; 95% CI, 0.91 to 1.61). This association was strongest in the frailest group. CONCLUSION: Self-reported chemosensory dysfunction and mOD are independently associated with measures of frailty, suggesting a novel method to assess or predict frailty.

Association Between Rhinitis and Depression in United States Adults.

BACKGROUND: Growing evidence suggests a link between allergic disorders and depression, but literature assessing the association between rhinitis and depression is conflicting, and large population-based studies are lacking. OBJECTIVE: To assess the association between depression and rhinitis in a representative sample of United States adults. METHODS: We performed a cross-sectional analysis of 4320 participants in the 2005-2006 National Health and Nutrition Examination Survey. Rhinitis was defined as self-reported hay fever and/or nasal symptoms in the past 12 months. Rhinitis was further stratified as allergic rhinitis (AR) if participants had a positive serum IgE or nonallergic rhinitis (NAR) if participants did not have a positive serum IgE to any aeroallergen. The outcome variable was depression, defined as a score ≥10 on the Patient Health Questionnaire-9. RESULTS: The odds of depression were 42% higher in subjects with rhinitis compared with those without rhinitis (odds ratio [OR]: 1.42, confidence interval [CI]: 1.03-1.95, P = .04) and 2 times higher in subjects with NAR compared with those without rhinitis (OR: 1.99, CI: 1.34-2.96, P = .002). Subjects with NAR had 64% higher odds of mild depression (OR: 1.64, CI: 1.32-2.02, P < .001) and 2.4 times higher odds of moderate depression (OR: 2.43, CI: 1.39-4.26, P = .004) compared with subjects with no rhinitis. CONCLUSIONS: Rhinitis is significantly associated with depression, and patients with NAR may be at higher risk of depression than those with AR. Although further studies are required to elucidate the relationship between rhinitis and depression, these findings reinforce the need to consider depression in patients undergoing evaluation for rhinitis.

Multiple bioabsorbable corticosteroid-eluting stent placement with associated skull base injury.

Bioabsorbable corticosteroid-eluting sinus stents (BCES) are used to optimize healing after sinus surgery. We report a patient with BCES placed through a dural defect. A 70 year old underwent sinus surgery. Postoperatively, the patient developed mental status changes. The patient was taken to the operating room and eight BCES were identified, with one extending through the skull base. The stents were extracted and the defect was repaired. The patient recovered well. This is the first significant complication associated with BCES. Thorough review of preoperative imaging, understanding of skull base anatomy, and careful use of BCES are critical for safety. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1494-1496, 2019.

Analysis of 24-hour surgical cancellations in an academic rhinology and skull base surgery practice.

BACKGROUND: Late cancellations within 24 hours of surgery lead to decreased utilization of operating room time with loss of productivity, decreased access to care, and inconvenience to patients and staff. To date, no studies have analyzed 24-hour cancellations in a tertiary rhinology practice. METHODS: All procedures performed at a tertiary rhinology/skull base practice from January 2016 to December 2017 were reviewed. Twenty-four-hour cancellations were analyzed by procedure type and reason for cancellation. Avoidable cancellations were late cancellations that could have been prevented by review of medical records or communication by hospital staff with the patient before surgery. Univariate analysis was performed to determine predictive factors for cancellations. RESULTS: A total of 39 of 640 surgical cases were cancelled (6.1%) within 24 hours of surgery. Of these, 69.2% were inflammatory and 30.8% were skull base cases. The mean number of operating room minutes lost was 151 (60 of 210) for inflammatory and 263 (102 of 480) for skull base cases. Avoidable cancellations were seen in 25 of 35 (71.4%) cases. Patients undergoing inpatient or skull base surgery were more likely to have medical cancellations than patients undergoing outpatient or inflammatory surgery (91.7% vs 43.5%, p = 0.01; 83.3% vs 47.8%, p = 0.07). CONCLUSION: This is the first study to analyze 24-hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancellations in rhinology and identify strategies to try to prevent them.

Association between allergic rhinitis and poor sleep parameters in U.S. adults.

BACKGROUND: Evidence suggests relationships between allergic rhinitis (AR) and poor sleep parameters, but population-based studies in the United States are lacking. This study investigates the relationship between AR and sleep parameters in a representative sample of U.S. adults. METHODS: Cross-sectional study of 5563 participants ≥18 years old from the 2005-2006 National Health and Nutrition Examination Survey who participated in the allergy and sleep questionnaires. The predictor variable was AR (self-reported hay fever and/or nasal symptoms in the past 12 months). The outcome variables were individual sleep parameters (sleep latency, sleep duration, sleep disorders, sleep habits, sleep medication use, daytime dysfunction). Covariates included age, gender, race, and obesity. RESULTS: The population-weighted prevalence of AR was 36.5%. Adjusting for covariates, subjects with AR had higher odds of sleep latency ≥30 minutes (OR 1.24; 95% CI, 1.01 to 1.51; p = 0.04), sleep apnea (OR 1.86; 95% CI, 1.22 to 2.82; p < 0.01), insomnia (OR 1.85; 95% CI, 1.04 to 3.32; p = 0.04), trouble falling asleep (OR 1.43; 95% CI, 1.17 to 1.75; p < 0.01), waking up during the night (OR 1.49; 95% CI, 1.11 to 1.99; p = 0.01), waking up too early in the morning (OR 1.46; 95% CI, 1.20 to 1.79; p < 0.01), feeling unrested during the day (OR 1.76, 95% CI, 1.43 to 2.16; p < 0.01), feeling overly sleeping during the day (OR 1.54; 95% CI, 1.25 to 1.90; p < 0.01), not getting enough sleep (OR 1.68; 95% CI, 1.41 to 1.99; p < 0.01), using sleep medication (OR 1.69; 95% CI, 1.23 to 2.33; p < 0.01), difficulty concentrating (OR 1.93; 95% CI, 1.30 to 2.88; p < 0.01), remembering (OR 1.91; 95% CI, 1.22 to 2.97; p < 0.01), managing finances (OR 1.68; 95% CI, 1.09 to 2.56; p = 0.02), working (OR 2.16; 95% CI, 1.45 to 3.22; p < 0.01), and getting things done (OR 2.35; 95% CI, 1.36 to 4.06; p < 0.01) due to daytime sleepiness. CONCLUSION: This analysis of a representative sample of U.S. adults revealed associations between AR and poor sleep parameters including prolonged sleep latency, insomnia, sleep apnea, sleep disturbances, sleep medication use, and daytime dysfunction. These findings reinforce the need to assess sleep quality in patients undergoing evaluation for AR.

Techniques in Septoplasty: Traditional Versus Endoscopic Approaches.

This article provides a review of modern techniques in the surgical management of the deviated septum with emphasis on the comparison of traditional versus endoscopic septoplasty approaches. Relevant anatomy and physiology of the nasal septum are discussed. A brief history of the evolution of the surgical approaches for the correction of a deviated septum is provided. Traditional and endoscopic septoplasty techniques are reviewed; the indications, advantages, and limitations of each approach are highlighted. Potential complications of septoplasty, with a focus on prevention and management, are also discussed.