The Effects of Nasal Surgery on Pulmonary Function: A Systematic Review and Meta‐Analysis

• Published in: The Laryngoscope Vol. 133; no. 11; pp. 2837 - 2845
• Main Authors: Baharmand, Iman, Sheikh‐Oleslami, Sara, Pascual Rodríguez, Athenea, Hernaiz‐Leonardo, Juan Carlos, Alim, Bader M., Javer, Amin R.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-11-2023; Wiley Subscription Services, Inc
• Subjects: deviated nasal septum; Meta-analysis; nasal surgery; pulmonary function; rhinoplasty; septoplasty; spirometry; Surgery; Systematic review; pulmonary function; spirometry; nasal surgery; rhinoplasty; septoplasty; deviated nasal septum
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30651

Objective
A deviated nasal septum (DNS) can result in an anatomical obstruction and impact lung function through prolonged suboptimal inspiration. Given the improvements in respiration reported by patients following septoplasty or septorhinoplasty (with or without inferior turbinate reduction), our study investigated the effect of these procedures on pulmonary function through a systematic review and meta‐analysis.
Data Sources
Medline, Embase, Cochrane Databases, Web of Science, and Google Scholar.
Review Methods
The review was registered with PROSPERO [CRD42022316309]. The study population was composed of adult patients (18–65) who were symptomatic with confirmed DNS. Extracted outcomes (pre‐operative versus postoperative) included the six‐minute walk test (6MWT) and pulmonary function tests (FEV1, FVC, FEV1/FVC, FEF25‐75, PEF). Meta‐analyses were performed using a random‐effects model.
Results
Three studies included measures of the 6MWT in meters and all three found a statistically significant increase in the distance walked after surgery with a mean difference of 62.40 m (95% CI 24.79–100.00). Statistically significant improvements in PFT outcomes were observed with a standard mean difference of 0.72 for FEV1 (95% CI 0.31–1.13), 0.63 for FVC (95% CI 0.26–1.00), and 0.64 for PEF (95% CI 0.47–0.82). Of the twelve studies which measured PFT outcomes, six showed statistically significant improvements, three studies showed mixed results, and three studies found no difference in PFT outcomes between pre‐and post‐surgery testing.
Conclusions
The present study suggests that pulmonary function does improve after nasal surgery for DNS, but the high heterogeneity observed in the meta‐analyses indicates that the evidence supporting this conclusion is low. Laryngoscope, 133:2837–2845, 2023
Our study suggests that pulmonary function does improve as a result of nasal surgery but the high heterogeneity observed in the meta‐analyses indicates that the evidence supporting this conclusion is low. The current criteria indicate that a 12% improvement in FEV1 or FVC following bronchodilator use is a clinically significant improvement. Based on this, the included studies showed combinations of statistically and/or clinically significant improvements in spirometry measures post‐surgery.