The nasal cycle is a normal physiological process involving alternating congestion and decongestion of the nasal cavities, yet patient awareness of this phenomenon is poorly understood. The objective of this study was to assess patient awareness of the nasal cycle and its association with nasal symptom perception and anxiety.

This prospective observational study included 120 adult ENT outpatients. A structured questionnaire assessed awareness of the nasal cycle, perception of alternating nasal obstruction and anxiety. Nasal symptom severity was measured using the Nasal Obstruction Symptom Evaluation score, and nasal airflow dominance was assessed with the cold spatula test.

Only 28.3 per cent of patients were aware of the nasal cycle. Although 51.7 per cent perceived alternating nasal obstruction, most considered it abnormal. Poor awareness was associated with higher Nasal Obstruction Symptom Evaluation scores (p = 0.01) and increased anxiety (p = 0.003).

Limited awareness of the nasal cycle leads to misinterpretation of normal physiology. Simple counselling may reduce symptom related anxiety.

This study aimed to assess whether intra-operative autologous platelet-rich fibrin glue accelerates nasal mucosal healing after septoplasty.

Prospective, randomised controlled trial of 100 adults undergoing septoplasty, randomised to platelet-rich fibrin glue (n = 50) or standard surgery (n = 50). Primary outcome: endoscopic healing via modified Lund–Kennedy score. Secondary outcomes: Visual Analog Scale pain, crusting, Nasal Obstruction Symptom Evaluation scores and complications.

Platelet-rich fibrin glue significantly accelerated epithelialisation at one week (2.72 vs. 3.46, p = 0.028) and two weeks (1.49 vs. 2.17, p = 0.006). Pain, crusting and Nasal Obstruction Symptom Evaluation scores improved significantly in the platelet-rich fibrin glue group during early follow-up (p < 0.05). No significant differences were observed between groups at four or 12 weeks. Complication rates were low and comparable.

Intra-operative platelet-rich fibrin glue accelerates early mucosal healing and reduces post-operative morbidity during first two weeks after septoplasty without increasing complications. These benefits are confined to early recovery, with equivalent long-term outcomes.

This study aimed to evaluate the association between the severity of nasal obstruction and carotid intima–media thickness in patients with nasal septal deviation.

This prospective study included 60 patients scheduled for septoplasty and 50 age-, sex- and body mass index–matched healthy controls. Correlation analyses and receiver operating characteristics curve analyses were performed to determine associations and optimal cutoff values.

Both right (0.62 ± 0.12 mm) and left (0.63 ± 0.12 mm) common carotid artery intima–media thickness values were significantly higher in the nasal septal deviation group compared to controls (0.51 ± 0.09 mm and 0.51 ± 0.07 mm, respectively; p < 0.001). Receiver operating characteristics analyses revealed that Visual Analogue Scale greater than or equal to 7.5 (sensitivity 85.7 per cent; specificity 67.4 per cent) and Nasal Obstruction Symptom Evaluation greater than or equal to 72.5 (sensitivity 92.9per cen; specificity 65.1 per cent) reliably predicted elevated carotid intima–media thickness (>0.7 mm).

Nasal septal deviation–related nasal obstruction was significantly associated with increased carotid intima–media thickness, suggesting a possible contribution to cardiovascular risk. Larger multicenter studies are warranted to validate these findings. The Australian New Zealand CTN: ACTRN12619000347167

This study aimed to determine what motivates rhinoplasty surgery after septoplasty, and the clinical characterisation of patients undergoing these interventions.

This is a retrospective observational study including all patients submitted to rhinoplasty after septoplasty between January 2018 and July 2023. Demographic, clinical and surgical data were collected using patients’ digital hospital records.

Of 219 patients who underwent rhinoplasty, 15 per cent (n = 33) had a previous history of septoplasty. All patients (n = 33) who had undergone septoplasty before rhinoplasty reported maintenance of nasal obstruction, with most patients presenting with nasal deformities upon physical examination (54%; n = 18), of which 15 per cent (n = 5) presented with nasal tip ptosis and with 9 per cent (n = 3) presenting with nasal septum perforation. The mean interval between septoplasty and rhinoplasty was 77 months. An open approach was used in 58 per cent of patients, and grafts in 73 per cent, most commonly columella struts, with cartilage harvested from the nasal septum in 55 per cent but requiring auricular cartilage in 18 per cent.

Persistent nasal obstruction is the main indication for rhinoplasty after septoplasty, commonly associated with residual septal deviation, nasal valve dysfunction or external nasal deformities. These findings emphasise the importance of a thorough pre-operative assessment of all nasal structures in patients with nasal obstruction. Rhinoplasty in this context often represents a more complex surgical challenge, frequently requiring an open approach and a greater use of cartilage grafts, sometimes harvested from sites beyond the nasal septum. A comprehensive approach that addresses both functional and aesthetic components during the primary surgery may reduce revision rates, facilitate easier corrective procedures if needed and improve long-term patient satisfaction.

To compare 12-month functional, aesthetic and scar outcomes after septorhinoplasty in patients with and without allergic rhinitis and to assess allergy symptoms in the allergic rhinitis group.

Ninety-six patients were included (allergic rhinitis, n = 47; non-allergic rhinitis, n = 49). No turbinate surgery was performed. Allergy symptoms (allergic rhinitis group) were rated pre-operatively and at 12 months using a visual analogue scale (VAS). At 12 months, all patients completed the Standardised Cosmesis and Health Nasal Outcomes Survey; scars were evaluated with the Stony Brook Scar Evaluation Scale and patient- and physician-reported VAS scores for scar and nasal shape.

The Standardised Cosmesis and Health Nasal Outcomes Survey, the Stony Brook Scar Evaluation Scale and scar VAS scores were similar between groups. Nasal shape VAS scores were higher in the non-allergic rhinitis group, significant only for physician ratings (p = 0.03). In the allergic rhinitis group, allergy VAS decreased from 39.32 ± 42.25 to 24.22 ± 31.96 (p < 0.001).

Allergic rhinitis does not adversely affect functional, aesthetic or scar outcomes after septorhinoplasty, and septorhinoplasty may clinically reduce allergy symptoms in patients with allergic rhinitis.

This study aimed to compare Merocel and Surgicel nasal packing following inferior turbinoplasty, focusing on post-operative bleeding, pain, discomfort and nasal obstruction.

A randomised controlled trial (2017–2021) was conducted in the Department of Otolaryngology, Changi General Hospital, Singapore. Sixty adults undergoing inferior turbinoplasty and/or septoplasty were randomised to receive Merocel or Surgicel packing. Standardised surgical and post-operative protocols were used. Outcomes—bleeding, pain, discomfort and nasal obstruction—were assessed on post-operative day 1 and post-operative days 5–7 using validated scales.

Fifty-eight patients completed the study (Merocel = 30; Surgicel = 28). On post-operative day 1, Surgicel had significantly lower nasal obstruction scores (1.57 ± 0.74 vs 2.10 ± 0.71; p = 0.008). By post-operative days 5–7, Merocel showed significantly less bleeding (0.77 ± 0.63 vs 1.18 ± 0.86; p = 0.044). Pain and discomfort were comparable.

Merocel provided superior sustained haemostasis, while Surgicel offered better early comfort. Both materials have comparable outcomes.

To assess the efficacy of intranasal cryotherapy to treat chronic rhinitis refractory to medical therapy.

An evaluation was performed for all patients (n = 36) with chronic rhinitis refractory to medical treatment who underwent intranasal cryotherapy between 2022 and 2024 at this centre. The primary outcome measures were changes in validated pre- and post-operative scoring systems (Total Nasal Symptom Score, Sino-Nasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation and peak inspiratory nasal flow).

Objective scoring pre- and post-procedure showed statistically significant improvement across all measures (p < 0.001): mean Total Nasal Symptom Score (12 hours) 8.4 to 5.3, Total Nasal Symptom Score (2 weeks) 9.2 to 5.9, SNOT-22 56 to 31, Nasal Obstruction Symptom Evaluation 57.5 to 28.5 and peak inspiratory nasal flow 98 to 138 l/min.

This is the only dataset for patients receiving intranasal cryotherapy in the UK to date and follows patients over a two-year period. The results support the ongoing use of intranasal cryotherapy for sustained treatment of refractory chronic rhinitis.

To compare between two methods of radiofrequency (coblation and radiofrequency volume reduction) in turbinate volume reduction under local anaesthesia regarding efficacy, pain, and crust formation.

In a prospective randomised double-blinded trial, 90 patients were randomised into two groups in a 1:1 ratio where group (I) underwent submucosal turbinate reduction using coblation radiofrequency while group (II) underwent turbinate reduction using conventional radiofrequency using radiofrequency volume reduction technique. Patients were assessed by Nasal Obstruction Symptom Evaluation for technique efficacy, pain visual analogue scale score, Endoscopic Turbinate Grading scale, and crust formation 1, 6, and 12 months post-operative.

Nasal Obstruction Symptom Evaluation score showed significant difference between patients in the same group compared to baseline (p < 0.001), pain visual analogue scale was significantly higher in radiofrequency group (p < 0.001) and there was no significant statistical difference regarding crust formation.

Both techniques are tolerable, effective, and safe for turbinate reduction under local anaesthesia in patients with mainly soft-tissue component turbinate hypertrophy.

Rosai–Dorfman disease is a rare histiocytic disorder typically presenting with cervical lymphadenopathy. Sinonasal involvement is uncommon and presents diagnostic and therapeutic challenges. This scoping review synthesises literature on the clinical presentation, diagnosis, management and outcomes of sinonasal Rosai–Dorfman disease.

We systematically searched PubMed, Scopus and Embase. Articles were screened using Endnote. Studies reporting sinonasal Rosai–Dorfman disease were included. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR (Scoping Review) guidelines.

Thirty studies comprising 36 patients were included. Common symptoms were nasal obstruction (80.6 per cent) and epistaxis (41.7 per cent). Computed tomography (75 per cent) and magnetic resonance imaging (36.1 per cent) were primary imaging modalities. Histopathology showed emperipolesis (66.7 per cent), S-100 (69.4 per cent) and CD68 (47.2 per cent) positivity. Management was mainly surgical (72.2 per cent), with corticosteroids (44.4 per cent), radiotherapy (5.6 per cent) and chemotherapy (5.6 per cent) used less frequently. Outcomes included complete resolution (38.9 per cent), stable disease (38.9 per cent) and recurrence (16.7 per cent).

Diagnosis relies on histopathology and imaging. Surgical procedures, often with corticosteroids, remain the primary treatment. Future research should guide diagnostic and treatment protocols.

We intended to investigate the deviation of septal swell body, perpendicular plate, septal spur and vomer in patients with and without nasal obstruction.

We compared the deviation of these septal areas in computed tomography scans of patients scheduled for nasal surgical procedures (cases) and of patients without clinically relevant nasal obstruction (controls).

Septal swell body was similarly deviated between 56 cases (median value: 6.5 mm) and 56 controls (6.4 mm; p > 0.2). Septal spur was more deviated in cases (5.6 mm) than in controls (4.7 mm; p < 0.001). The deviation of perpendicular plate (found in 28/112 subjects) did not differ significantly between cases (3.0 mm) and controls (2.2 mm; p > 0.2). The deviation of vomer (found in 71/112 subjects) was larger in cases (7.1 mm) than in controls (4.3 mm; p = 0.001).

Septal spur, vomer and perpendicular plate were more frequent causes of nasal obstruction compared to septal swell body.

Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument.

Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity.

Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having ‘severe’ or ‘extreme’ nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction.

The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery.

Rhinitis medicamentosa poses a therapeutic challenge for both patients and physicians. Treatment strategies vary, starting with avoidance of decongestants, followed by medications or surgical intervention. This study aimed to compare two treatment strategies for this condition.

A review was conducted of patients diagnosed with rhinitis medicamentosa from 2013 to 2021, who were managed conservatively with medications or surgically by inferior turbinate reduction.

Forty-seven patients were included: 21 patients were treated conservatively and 26 underwent turbinate reduction. Following surgical therapy, the frequency of using decongestants was significantly reduced (p < 0.001), with a significant improvement in Sino-Nasal Outcome Test-22 scores (p < 0.001). The conservative treatment group was significantly older with more co-morbidities. Following medical therapy, the conservative treatment group had a significant decrease in the frequency of decongestant use, but there was no significant improvement in their Sino-Nasal Outcome Test-22 scores.

Compared to conservative treatment, inferior turbinate reduction for rhinitis medicamentosa resulted in reduced decongestant use and improved quality of life.

To assess the efficacy of budesonide intrapolyp injection in chronic rhinosinusitis with nasal polyps.

Ninety patients were divided into three groups; group A was given oral prednisolone, group B was given budesonide intrapolyp injection weekly for five consecutive weeks and group C was given budesonide as nasal irrigation for one month. Patients were assessed using Sino-Nasal Outcome Test 22 score, total nasal polyp score, serum immunoglobulin E, absolute eosinophilic count, and morning cortisol level before treatment, one week and three months after completing their treatment.

Total nasal polyp score decreased significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was greater than the wash group (p2 = 0.004), (p3 < 0.001), and the same trend concerning Sino-Nasal Outcome Test 22 score (p2 < 0.001), (p3 < 0.001).

Budesonide is an effective agent used in intrapolyp injection with no documented systemic or visual side effects that has comparable results with oral steroids.

This study investigated the psychological status of patients with unilateral or bilateral complete nasal obstruction.

The study included 49 consecutive cases of unilateral or bilateral complete nasal obstruction. In order to assess participants’ personality traits, both groups completed the Personality Belief Questionnaire, State–Trait Anxiety Inventory form, Beck Depression Inventory and Beck Anxiety Inventory.

The groups were similar in terms of demographic characteristics. Patients with unilateral or bilateral complete nasal obstruction had higher scores on all the psychological assessments compared with the healthy controls, except for the Beck Anxiety Inventory. Although all personality assessment scores were higher in patients, the only differences that were statistically significant were in the dependent, antisocial and avoidant personality trait scores.

The psychological conditions of patients with structural deformities that cause nasal obstruction may be affected, and appropriate treatment should be provided to improve their symptoms and quality of life.

To explore the effects of pharyngeal packing on antral cross-sectional area, gastric volume and post-operative complications.

In this prospective, randomised, controlled study, 180 patients were randomly assigned to a control group or a pharyngeal packing group. Gastric antral dimensions were measured with pre- and post-operative ultrasound scanning. Presence and severity of post-operative nausea and vomiting and sore throat were recorded.

Post-operative antral cross-sectional area and gastric volume were significantly larger in the pharyngeal packing group compared to the control group. The incidence and severity of post-operative nausea and vomiting were significantly less in the pharyngeal packing group. More frequent and severe sore throat was observed in the control group within the ward. An increased Apfel simplified risk score and post-operative antral cross-sectional area were associated with post-operative nausea and vomiting during the first 2 hours, whereas septorhinoplasty and functional endoscopic sinus surgery, absent pharyngeal packing, and lower American Society of Anesthesiologists’ physical status were associated with post-operative nausea and vomiting within the ward.

Regardless of operation type, pharyngeal packing use resulted in smaller gastric volume, which was associated with reduced post-operative nausea and vomiting frequency and severity, and lower sore throat incidence.

A statistically significant improvement in nasal obstruction ratings following septoplasty is not necessarily clinically important. This study aimed to establish useful measures of septoplasty success, namely the minimal clinically important difference and the desirable clinically important difference.

Patients rated nasal obstruction on a 0–100 visual analogue scale pre-operatively and at 5.5 months post-operatively. Global outcome rating (completely, much, or somewhat improved, unchanged or worse) served as the anchor post-operatively. Minimal clinically important difference is the visual analogue scale value between ‘somewhat improved’ and ‘unchanged’, and the desirable clinically important difference is that between ‘much’ and ‘somewhat improved’.

Statistically significant improvement in visual analogue scale scores was not clinically important. The minimal clinically important difference (daytime value of 9.5) represented 15.1 per cent improvement and the desirable clinically important difference (daytime value of 28.5) represented 45.2 per cent, without gender or age differences.

Clinical success can be defined using a minimal clinically important difference of 15 per cent improvement over a patient's baseline value. Other studies’ ratings of ‘satisfactory’ outcome coincided with a desirable clinically important difference of 45 per cent over baseline. These values are suggested as relevant indicators of septoplasty success.

This study aimed to examine the association between nasal septal deviation and antrochoanal polyp.

This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp.

Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp.

The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.

Post-operative success and patient satisfaction were assessed following septoplasty for mild to severe anterior septal deviation.

The study included patients with an anterior nasal septal deviation in the form of a ‘C’ shape and close to the nasal valve in the anterior septal area. Deviation severity was classified as severe (group 1), moderate (group 2) or mild (group 3). Open or closed septoplasty procedures were performed. All patients were surveyed twice using the Nasal Obstruction Symptom Evaluation scale and the 36-Item Short Form Health Survey.

The mean Nasal Obstruction Symptom Evaluation score for group 1 was 15.58 ± 2.34 prior to surgery and 6.61 ± 3.29 following surgery. The corresponding pre- and post-surgery scores in group 2 were 11.9 ± 2.82 and 6.3 ± 3.03, respectively. In group 3, these values were 8.28 ± 2.63 and 7.12 ± 3.18, respectively. The mean 36-Item Short Form Health Survey physical function value for groups 1 and 2 increased after surgery; in group 3, this value decreased after surgery, but the result was not statistically significant.

Septoplasty is very successful for treating moderate or advanced deviations, but great care should be taken when employing septoplasty for mild deviations.

Nasal obstruction and congestion can occur because of turbinate and septal variations with or without rhinitis. A combined treatment for nasal obstruction and congestion was examined retrospectively in cases where the nasal swell body was addressed with inferior turbinectomy, with or without posterior nasal nerve ablation.

A 940 nm laser was utilised for contact (nasal swell body, septum and inferior turbinate) and non-contact (posterior nasal nerve) ablation. Total Nasal Symptoms Score, visual analogue scale pain score, complications and procedure location (office vs operating theatre) were recorded.

All 242 patients underwent nasal swell body reduction with inferior turbinate reduction, and 150 had posterior nasal nerve ablation also. No laser complications were observed. An 80 per cent reduction in medication usage was noted. Total Nasal Symptoms Score decreased by 73 per cent; rhinorrhoea and congestion scores decreased by 54 per cent and 81 per cent respectively. Crusting, epistaxis and infections were minimal, and resolved within two weeks.

Nasal swell body with inferior turbinate reduction, with or without posterior nasal nerve ablation, is a new method of treating nasal obstruction and congestion. Laser posterior nasal nerve ablation can be utilised as a complementary tool to deliver anatomical obstruction relief.