In adults with nasal obstruction associated with a deviated nasal septum, surgical intervention is more effective than medical management with nasal steroids and saline spray, researchers report. In the Nasal Airways Obstruction Study (NAIROS), participants who had septoplasty had significantly greater improvement in nasal obstruction and quality of life compared with those on a defined medical management regimen.
At 17 otolaryngology clinics, investigators recruited 378 adult participants who were newly referred with symptoms of nasal obstruction associated with septal deviation and at least moderate symptoms of nasal obstruction (score >30 on the Nasal Obstruction and Symptom Evaluation [NOSE] scale). They were randomized to septoplasty or defined medical management (nasal steroid and saline spray for 6 months. The primary outcome measure was patient patient-reported score on the Sino-Nasal Outcome Test-22 (SNOT-22) at 6 months, with 9 points defined as the minimal clinically important difference.
“Mean SNOT-22 scores at six months were 19.9 (95% confidence interval 17.0 to 22.7) in the septoplasty arm (n = 152, intention-to-treat population) and 39.5 (36.1 to 42.9) in the medical management arm (n = 155); an estimated 20.0 points lower (better) for participants randomised to receive septoplasty (95% confidence interval 16.4 to 23.6, P <0.001, adjusted for baseline continuous SNOT-22 score and the stratification variables sex and baseline NOSE severity categories). Greater improvement in SNOT-22 scores was predicted by higher baseline symptom severity scores. Quality of life outcomes and nasal airflow measures (including peak nasal inspiratory flow and absolute inhalational nasal partitioning ratio) improved more in participants in the septoplasty group. Readmission to hospital with bleeding after septoplasty occurred in seven participants (4% of 174 who had septoplasty), and a further 20 participants (12%) required antibiotics for infections.”