Septoplasty more effective than nasal sprays

Straightening a crooked septum through surgery is more effective than treatment with nasal sprays, according to a trial reported today.

UK researchers, led by a team at Newcastle Upon Tyne Hospitals NHS Foundation Trust, who designed the Nasal Airways Obstruction Study (NAIROS) to provide definitive evidence and recommendations for use of septoplasty, say the procedure should be offered to adults with at least moderate symptoms such as breathing disruption.

The study, published in today’s edition of The BMJ, involved 378 adults. Their average age was 40 and 67% were men. All had at least moderate symptoms of nasal obstruction linked to septal deviation, which had been confirmed by a score of more than 30 on the Nasal Obstruction and Symptom Evaluation (NOSE) scale.

Participants were randomly split into two groups, with 188 receiving septoplasty and 190 receiving a nasal steroid and saline spray.

After six months, patients completed the Sino-Nasal Outcome Test-22 (SNOT-22), which assesses 22 symptoms, each scored from zero to five, with higher scores indicating worse symptoms.

The average SNOT-22 scores at six months were 19.9 in the septoplasty group and 39.5 in the medical management group and at 12 months the scores were 21.2 in the surgery group and 30.4 in the medical management group.

Patients who had more severe symptoms at the start of the study reported greater improvement after septoplasty compared with medical management. Quality of life outcomes and nasal airflow measures also improved more in participants in the septoplasty group.

They write: “Septoplasty is a superior treatment for nasal obstruction associated with septal deviation compared with a defined regimen of nasal steroid and saline sprays.”

Carrie S, O’Hara J, Fouweather T et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ 19 October 2023; doi: 10.1136/bmj-2023-075445



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