Inserting by the nose: a new test will help assess the patient's condition before rhinoplasty

Russian doctors have started using a new diagnostic method to assess the condition of patients before repeated surgery on the nasal septum. Objective measurements make it possible to determine whether another intervention is really required or whether breathing problems are related to another pathology. Septal correction is one of the most common ENT procedures, while repeated surgery is usually more difficult than the first and carries a risk of complications. According to experts, such personalized examinations should eventually become the standard of surgical practice.

Diagnosis of nasal breathing

Specialists of the Sechenov University Ear, Throat and Nose Diseases Clinic have begun to apply a new method of examining patients before repeated surgery on the nasal septum — septoplasty, which is performed to improve breathing. Such an intervention is required only in individual cases and is usually more difficult than the first one, since the patient already has anatomical and morphological changes. The test developed by doctors allows you to objectively assess how much the shape of the septum affects breathing, and to understand whether its correction is really necessary.

Photo: TASS/Alexander Artemenkov

— The basis of a personalized examination before repeated surgery is the measurement of objective indicators, in particular, the parameters of nasal breathing using anterior active rhinomanometry. The patient breathes into a special mask, and the device evaluates the level of resistance to airflow in the nasal cavity. The study is carried out in two stages: before the introduction of vasoconstrictor drugs and after. If breathing improves after using them, it means that the problem is not related to the nasal septum, but to the vessels of the lower nasal concha, and this pathology requires a different treatment strategy," said Zhanna Mokoyan, assistant professor at the Department of Ear, Throat and Nose Diseases at Sechenov University.

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If breathing remains difficult after the test, doctors additionally perform a CT scan of the sinuses. This allows us to assess the presence and localization of the residual curvature of the septum, as well as exclude other possible causes of impaired nasal breathing, she added.

Photo: RIA Novosti/Alexey Sukhorukov

According to the medical literature, up to 50% of patients are not satisfied with the results of septoplasty. They repeatedly turn to ENT specialists to eliminate the shortcomings of the previous intervention, said Sechenov University.

— Septoplasty is the most common ENT surgery today, the purpose of which is to improve nasal breathing. The most common indication for repeated intervention is a previously unresolved curvature of the nasal septum. When planning an audit intervention, it is important to pinpoint the cause of the inefficiency of the first operation. Such operations are always a difficult clinical task, since the patient already has anatomical and morphological changes after the initial intervention," said Zhanna Mokoyan.

Photo: RIA Novosti/Ilya Pitalev

Now Sechenov University specialists continue to develop the technology.

— A comprehensive assessment of objective and subjective indicators of the patient's condition before repeated surgery on the nasal septum allows otorhinolaryngologists to achieve high efficiency of operations — without relapses and complications. Currently, clinicians are developing precision access techniques to perform operations to eliminate curvatures in more inaccessible parts of the nasal cavity," said Valery Svistushkin, director of the Ear, Throat and Nose Diseases Clinic.

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Standard of Surgery

Rhinomanometry allows you to assess all possible risks before the patient goes to the operating table, so that there is no need for repeated rhinoplasty. In addition, such an intervention can lead to a decrease and difficulty in mucociliary clearance, that is, the protective mechanism of the respiratory tract mucosa, explained ENT surgeon Alesya Shapovalova of the GUTA CLINIC.

— Often, a patient with a curved nasal septum requires correction of the nasal structures, since due to the deformation of the septum, the shape of the nasal passages and nasal concha changes. To avoid repeated interference, we do everything at once — we adjust both the partition and the nasal structures," she told Izvestia.

Photo: TASS/Sergey Malgavko

Measuring the pressure in the nasal cavity allows you to get an objective picture of the air flow disturbance. A two—stage examination — before and after the administration of drugs - helps to distinguish between two fundamentally different conditions: reversible mucosal edema and persistent anatomical deformity. This is especially important during repeated operations, when the tissues have already been changed by a previous intervention: the scarring process can mimic or, conversely, mask the true obstacle. In such a situation, the surgeon needs to understand exactly what problem he is dealing with, added Olga Chernova, an otorhinolaryngologist, plastic surgeon, curator of the Otorhinolaryngology department of the Semeynaya clinic network.

— Does this approach help to avoid complications? There is no direct connection here: rhinomanometry alone does not reduce operational risks. But it reduces the likelihood of mistakes when deciding whether to operate on a patient or not, which structures need to be adjusted, and what the actual functional deficit is. And that's a lot," the doctor noted.

A personalized examination algorithm is the standard that modern surgery should strive for, she stressed.