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Impact of septoplasty on pulmonary function.

INTRODUCTION

Deviated nasal septum (DNS) is one of the most common causes of upper airway obstruction seen in a large number of population. [1] 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. [2] 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. [3] 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. [4] 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.

RESULTS

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].

DISCUSSION

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. [5] 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. [6] Karaman et al. also found improvement in spirometry findings 3 months after septoplasty. [7] Shturman-Ellstein et al. showed worsened lower airway function in mouth breathers with obstructed nose as compared to nasal breathers. [8] Similar improvements were obtained by Niedzielska et al. after adenoidectomy [9] and Karuthedath et al. after endoscopic sinus surgery. [10]

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. [11] Similar results were obtained in other studies in literature. [12]

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.

CONCLUSION

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.

ACKNOWLEDGMENTS

We thank our Medical College and Hospital for its support and the patients for participating in the study protocol.

REFERENCES

[1.] Gray LP. Deviated nasal septum. Incidence and etiology. Ann Otol Rhinol Laryngol Suppl 1978;87:3-20.

[2.] Kurtaran H, Ark N, Sadikoglu F, Ugur KS, Yilmaz T, Yildirim Z, et al. The effect of anterior nasal packing with airway tubes on pulmonary function following septoplasty. Turk J Med Sci 2009;39:537-40.

[3.] Licari A, Castagnoli R, Denicolo CF, Rossini L, Marseglia A, Marseglia GL, et al. The nose and the lung: United airway disease? Front Pediatr 2017;5:44.

[4.] Vyas HP, Vinchhi RP, Sheth MS, Vyas NJ. Comparison of pulmonary function among smokers and non -smokers--A retrospective study. Int J Med Sci Public Health 2014;3:1232-4.

[5.] Amer S, Abdullah D, Ammar M. Assessment of nasal septal deformities by anterior rhinoscopy and nasal endoscopy. Tikrit Med J 2010;16:14-20.

[6.] Bulcun E, Kazkayasi M, Ekici MA, Tahran FD, Ekici M. Effects of septoplasty on pulmonary function tests in patients with nasal septal deviation. J Otolaryngol Head Neck Surg 2010;39:196-202.

[7.] Karaman M, Tek A, Tuncel A, Erdem Abbasoglu T. Evaluation of patients with septal deviation using respiratory function tests before and after septoplasty. Kulak Burun Bogaz Bas Boyun Cerrahi Derg 2011;19:1-5.

[8.] Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF. The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis 1978;118:65-73.

[9.] Niedzielska G, Kotowski M, Niedzielski A. Assessment of pulmonary function and nasal flow in children with adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2008;72:333-5.

[10.] Karuthedath S, Singh I, Chadha S. Impact of functional endoscopic sinus surgery on the pulmonary function of patients with chronic rhinosinusitis: A Prospective study. Indian J Otolaryngol Head Neck Surg 2014;66:441-8.

[11.] Panicker VB, Belaldavar BP. Effectiveness of septoplasty on pulmonary function tests in symptomatic deviated nasal septum cases: A prospective study. Int J Otorhinolaryngol Head Neck Surg 2018;4:800-7.

[12.] Mahmood K, Fareed T, Tabassum R. Management of deviated nasal septum. J Pharm Sci Res 2011;3:918-22.

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: panav66@yahoo.com

Received: Janaury 02, 2019; Accepted: Janaury 21, 2019

Source of Support: Nil, Conflict of Interest: None declared.

DOI: 10.5455/njppp.2019.9.0101821012019
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
Words:1938
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