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Original Investigation
November 15, 2018

Health Impairment From Nasal Airway Obstruction and Changes in Health Utility Values From Septorhinoplasty

Author Affiliations
  • 1Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
  • 2University of Sydney Medical School, Sydney, Australia
  • 3Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
JAMA Facial Plast Surg. Published online November 15, 2018. doi:10.1001/jamafacial.2018.1368
Key Points

Question  What is the association of nasal airway obstruction and subsequent open septorhinoplasty with health utility values?

Findings  In this case series study, health utility values of 144 patients with nasal airway obstruction who underwent open septorhinoplasty were assessed before and 6 months after the procedure; baseline health utility values were lower than the Australian norm and similar to those in individuals with chronic diseases with significant health expenditure. There was a clinically and statistically significant improvement in health utility values after open septorhinoplasty.

Meaning  The findings suggest that nasal airway obstruction is associated with health outcomes and that open septorhinoplasty may be clinically beneficial for improving health outcomes.

Abstract

Importance  The association of nasal airway obstruction with health is significant, and the health care resources utilized in open septorhinoplasty need to be included in health economic analyses.

Objectives  To describe the association of nasal airway obstruction and subsequent open septorhinoplasty with patient health.

Design, Setting, and Participants  A prospective case series study was conducted from September 30, 2009, to October 29, 2015, at 2 tertiary rhinologic centers in Sydney, Australia, among 144 consecutive adult patients (age, ≥18 years) with nasal airway obstruction from septal and nasal valve disorders.

Interventions  Open septorhinoplasty.

Main Outcomes and Measures  Patients were assessed before undergoing open septorhinoplasty and then 6 months after the procedure. Health utility values (HUVs) were derived from the 36-Item Short Form Health Survey. Nasal obstruction severity was also measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and the Sino-Nasal Outcome Test 22 questionnaires.

Results  A total of 144 patients (85 women and 59 men; mean [SD] age, 38 [13] years) were assessed. The baseline mean (SD) HUV for patients in this study was 0.72 (0.09), which was below the weighted mean (SD) Australian norm of 0.81 (0.22). After open septorhinoplasty, the mean (SD) HUV improved to 0.78 (0.12) (P < .001). Improvements in HUV were associated with changes in disease-specific patient-reported outcome measures, including Nasal Obstruction Symptom Evaluation scores (r = –0.48; P = .01) and Sino-Nasal Outcome Test 22 scores (r = −0.68; P = .01).

Conclusions and Relevance  Patients with nasal airway obstruction reported baseline HUVs that were lower than the Australian norm and similar to those in individuals with chronic diseases with significant health expenditure. There was a clinically and statistically significant improvement in HUVs after open septorhinoplasty that was associated with a reduction in Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores. Outcomes from this study may be used for health economic analyses of the benefit associated with open septorhinoplasty.

Level of Evidence  4.

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