Impact of septoplasty on pulmonary function.
Deviated nasal septum (DNS) is one of the most common causes of upper airway obstruction seen in a large number of population.  Septoplasty is the surgery of choice for DNS. DNS leads to upper airway obstruction, but question is if it does have any effect on lower airways. Nose performs important functions such as respiration, filtration, humidification, and olfaction.  DNS leads to imparting of these functions of the nose. Due to obstruction of nose seen in DNS, dry and cold air and other particles can enter the lower airway and can cause bronchoconstriction and lower airway irritation.  Hence, there seems a relation between upper and lower airways.
Spirometry is one of the simple, easily, readily available, and cheap methods using simple equipments for analyzing the pulmonary function.  It gives information about the condition of lower airways by performing pulmonary function tests. It gives information whether the patient has obstructive or restrictive lung disease.
Not many studies are available regarding the improvement in pulmonary function after surgical correction of nasal septum and almost none in our region. There is a need to find a correlation between the diseases of upper and lower airways. Hence, this study was planned to assess the changes in pulmonary (lower airway) function after correction of nasal septal deviation (upper airway obstruction) by undergoing septoplasty.
MATERIALS AND METHODS
This study was conducted in Allergy and Asthma Clinic attached to the Department of ENT of our Medical College and Hospital from March 2018 to November 2018 after approval of the Institutional Ethics Committee. A total of 50 patients between the age groups of 18 and 60 years with DNS with the complaint of nasal obstruction and planned for septoplasty who gave consent for the study were taken up for the study. The patients with a history of allergic rhinitis, asthma, chronic obstructive pulmonary disease, chronic rhinosinusitis, and nasal polyposis, chronic smokers, and those on nasal or inhaled steroids were excluded from the study.
All the 50 patients preoperatively underwent detailed history taking and physical examination including chest and nasal examination. Nasal examination was done using 0[degrees] and 30[degrees] Hopkins nasal endoscopes. All these patients underwent spirometry. Patients were evaluated for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV-1), and the ratio of both FEV-1 and FVC. The spirometer used was RMS Helios 401 spirometer.
All these patients were then taken up for surgery under general anesthesia or under monitored anesthetic control. Patients again underwent spirometry postoperatively 1 month after surgery. The results were noted and analyzed using mean and standard deviation. The statistical analysis was performed using unpaired t-test by means of P value and 95% confidence interval.
The patients were analyzed for:
* A difference in spirometry findings pre- and post-operatively.
* A difference in spirometry findings pre- and postoperatively depending on age group, gender, and duration of nasal obstruction.
Most of the patients were of younger age group of 18-40 years of age. There was almost equal distribution of patients among males and females [Table 1]. The maximum number of patients had nasal obstruction for 1-5 years [Figure 1].
There was an improvement in the values of FVC% and FEV-1% 1 month after surgery. The results were also found to be statistically significant [Table 2]. The improvement in FVC% and FEV-1% was found more in younger age group as compared to the middle age group [Table 3]. There was no significant difference in the improvement of FVC% and FEV-1% among males and females [Table 4].
The improvement of FVC% and FEV-1% was more significant when the duration of nasal obstruction was <1 year. There was less improvement for duration between 1 and 5 years, whereas there was no improvement in these values for a longer duration of nasal obstruction [Table 5].
DNS is one of the major diseases encountered in ENT out patient department. According to a study by Amer et al., it is commonly seen in males and in younger age group.  In our study also, we found it to be more common in younger age group but almost equal incidence among males and females [Table 1].
In our study, these patients with DNS underwent septoplasty and were evaluated pre- and post-surgery for pulmonary function by spirometry. We found significant improvement in pulmonary indices 1 month after surgery and the results were both clinically and statistically significant [Table 2]. Similar results were obtained by various other studies in literature. Bulcun et al. also showed improvement in pulmonary function after septal surgery.  Karaman et al. also found improvement in spirometry findings 3 months after septoplasty.  Shturman-Ellstein et al. showed worsened lower airway function in mouth breathers with obstructed nose as compared to nasal breathers.  Similar improvements were obtained by Niedzielska et al. after adenoidectomy  and Karuthedath et al. after endoscopic sinus surgery. 
In our study, we found improvement in pulmonary function more in younger age group as compared to middle age group [Table 3] and more in patients with shorter duration of nasal obstruction [Table 5]. There was no difference among males and females [Table 4]. Another study also showed lesser improvement in pulmonary function after surgery in older age group and also in patients with longer duration of nasal blockage.  Similar results were obtained in other studies in literature. 
The limitation of our study was patients with significant pulmonary disease such as obstructive and restrictive lung disease who were not taken up in the study. Patients who have allergic complaints and who smoke were also excluded from the study. More studies are needed to analyze the impact on septoplasty on pulmonary function on such patients.
There is a strong correlation between treatment for nasal obstruction and improvement in pulmonary function. Septoplasty for correction of upper airway obstruction leads to improvement in pulmonary function. This improvement is more marked in younger age groups and is more seen in nasal obstruction of shorter duration. There is no difference in pulmonary function improvement among males and females.
We thank our Medical College and Hospital for its support and the patients for participating in the study protocol.
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Manpreet Singh Nanda (1), Mandeep Kaur (2), Rama Devi (1)
(1) Department of ENT, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India, (2) Department of Anaesthesia, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India
Correspondence to: Mandeep Kaur, E-mail: firstname.lastname@example.org
Received: Janaury 02, 2019; Accepted: Janaury 21, 2019
Source of Support: Nil, Conflict of Interest: None declared.
Table 1: Age and sex distribution Age group (years) Males Females Total 18-40 17 17 34 41-60 10 06 16 Total 27 23 50 Table 2: Pre-operative and post operative spirometry findings Indices (%) Pre-Operative Post-Operative (Mean[+ or -]SD) (Mean[+ or -]SD) P-value FVC 73.08[+ or -]14.67 82.38[+ or -]15.29 0.025 FEV-1 75.19[+ or -]13.82 83.21[+ or -]14.07 0.049 FEV-1/FVC 102.9[+ or -]16.17 100.4[+ or -]14.38 0.416 Indices (%) 95% (CI) FVC -15.2467-3.3533 FEV-1 -13.5549-2.4851 FEV-1/FVC -3.5729-+8.5729 SD: Standard deviation, FVC: Forced vital capacity, FEV-1: Forced Expiratory Volume in 1 s, CI: Confidence Interval Table 3: Pre-operative and post-operative spirometry findings according to age group Indices Pre-operative (mean[+ or -]SD) Age group (%) 18-40 years 41-60 years FVC 74.81[+ or -]14.08 70.16[+ or -]15.25 FEV-1 76.82[+ or -]16.11 72.24[+ or -]14.18 FEV-1/FVC 103.2[+ or -]18.18 102.8[+ or -]13.66 Indices Post-operative (mean[+ or -]SD) Age group (%) 18-40 years 41-60 years FVC 86.25[+ or -]13.18 76.08[+ or -]15.33 FEV-1 86.61[+ or -]11.72 76.14[+ or -]14.17 FEV-1/FVC 100.3[+ or -]16.08 100.1[+ or -]12.72 FVC: Forced vital capacity, FEV-1: Forced Expiratory Volume in 1 s Table 4: Pre-operative and post-operative spirometry findings according to gender Indices Pre-operative Post-operative (mean[+ or -]SD) (mean[+ or -]SD) Gender (%) Males Females Males FVC 76.18[+ or -]15.72 69.82[+ or -]12.18 85.20[+ or -]13.18 FEV-1 76.23[+ or -]13.79 74.17[+ or -]14.07 84.18[+ or -]13.82 FEV-1/FVC 100.3[+ or -]15,88 105.7[+ or -]16.21 99.1[+ or -]15.72 Indices Post-operative (mean[+ or -]SD) Gender (%) Females FVC 77.17[+ or -]15.27 FEV-1 81.91[+ or -]14.36 FEV-1/FVC 103.3[+ or -]14.87 FVC: Forced vital capacity, FEV-1: Forced Expiratory Volume in 1 s Table 5: Pre-operative and post-operative spirometry findings according to duration of nasal obstruction Indices Pre-operative (mean[+ or -]SD) Nasal obstructive <1 Year 1-5 Years duration (%) FVC 74.16[+ or -]16.18 73.32[+ or -]15.09 FEV-1 76.08[+ or -]14.33 76.17[+ or -]15.92 FEV-1/FVC 102.1[+ or -]16.28 103.2[+ or -]15.97 Indices Pre-operative Post-operative (mean[+ or -]SD) Nasal obstructive (mean[+ or -]SD) duration (%) >5 Years <1 Year FVC 73.68[+ or -]15.28 86.38[+ or -]12.73 FEV-1 74.19[+ or -]14.71 86.29[+ or -]11.18 FEV-1/FVC 101.4[+ or -]16.34 99.8[+ or -]17.17 Indices Post-operative (mean[+ or -]SD) Nasal obstructive 1-5 Years >5 Years duration (%) FVC 77.17[+ or -]13.22 69.82[+ or -]13.18 FEV-1 81.91[+ or -]13.09 74.17[+ or -]15.22 FEV-1/FVC 103.3[+ or -]16.83 105.7[+ or -]16.29 FVC: Forced vital capacity, FEV-1: Forced Expiratory Volume in 1 s
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|Title Annotation:||RESEARCH ARTICLE|
|Author:||Nanda, Manpreet Singh; Kaur, Mandeep; Devi, Rama|
|Publication:||National Journal of Physiology, Pharmacy and Pharmacology|
|Date:||Mar 1, 2019|
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