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Original Investigation
Jul/Aug 2018

Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty

Author Affiliations
  • 1Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
  • 2Bondi Junction Private Hospital, Bondi Junction, Australia
  • 3Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
JAMA Facial Plast Surg. 2018;20(4):284-291. doi:10.1001/jamafacial.2018.0001
Key Points

Question  Is preoperative mental well-being associated with patient-reported and objective functional outcomes of rhinoplasty?

Findings  In this case-control study, patients with poor mental well-being had equal or greater improvements in both subjective and objective nasal function compared with controls following rhinoplasty.

Meaning  Rhinoplasty imparts similar benefits to nasal function regardless of mental well-being.


Importance  Mental health can have an impact on patient satisfaction with rhinoplasty. However, the association between mental health and patient satisfaction with functional outcomes of rhinoplasty is poorly understood.

Objective  To determine whether preoperative mental health is associated with satisfaction with functional outcomes of rhinoplasty.

Design, Setting, and Participants  This case-control study assessed baseline nasal function and postsurgical functional outcomes for 88 consecutive patients undergoing rhinoplasty with both cosmetic and functional goals at 2 tertiary rhinologic centers in Sydney, Australia.

Exposures  Poor mental well-being was defined preoperatively by the Optum SF-36v2 Health Survey mental component summary.

Main Outcomes and Measures  Nasal function was assessed with patient-reported outcome measures, including visual analog scales, the Nasal Obstruction Symptom Evaluation Scale (NOSE), the 22-item Sinonasal Outcome Test (SNOT-22), and Likert scales. Objective outcomes included nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. All outcomes were assessed preoperatively and 6 months postoperatively. The 36-item Optum SF-36v2 Health Survey mental component summary was used to assess mental well-being, with a score of less than 40 indicating poor mental well-being and a score 40 or higher indicating normal well-being.

Results  Mean (SD) patient age was 37.6 (12.9) years and 53 of 88 (60.2%) were women. The mental component summary defined impaired well-being in n = 24 (cases) and normal well-being in n = 64 (controls). There were improvements in the total study population across most nasal function outcomes and in both groups. After rhinoplasty, benefit was seen for both groups in visual analog scale (left side mean [SD] change, 18 [30]; P < .001 and right side mean [SD] change, 24 [30]; P < .001); NOSE (mean [SD] change, 1.35 [1.21]; P < .001); and SNOT-22 (mean [SD] change, 0.81 [0.88]; P < .001) scores. Nasal peak inspiratory flow improved for both groups (mean [SD] change, 32 [45] L/min; P < .001), while nasal airway resistance and minimum cross-sectional area remained similar (change in nasal airway resistance, 0.086 Pa/cm3/s; 95% CI, −0.007 Pa/cm3/s to 0.179 Pa/cm3/s and change in minimum cross-sectional area, −0.04 cm2; 95% CI, −0.21 cm2 to 0.13 cm2). Patients with poor mental health had similar improvements in nasal function compared with controls.

Conclusions and Relevance  Rhinoplasty imparts similar benefits to nasal function assessed by patient-reported outcome measures and objective airflow measures regardless of preoperative mental health status.

Level of Evidence  3.