Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty

Strazdins E, Nie YF, Ramli R, Palesy T, Christensen JM, Alvarado R, Marcells GN, Harvey RJ.

PubMed 29450446 Publisher (DOI)Free full text (PMC)

What this paper says

Among 88 rhinoplasty patients, the 24 with poor preoperative mental well-being had similar improvements in breathing at 6 months as the 64 with normal well-being, on both questionnaires and airflow measurements.

Overview

Mental health is known to affect satisfaction with cosmetic results, but its relationship to satisfaction with breathing outcomes had not been established. This case-control study at two tertiary rhinology centers in Sydney compared functional results between patients with and without impaired mental well-being before surgery.

Sections of note

88 consecutive patients undergoing rhinoplasty with both cosmetic and functional goals; mean age 37.6 years SD 12.9; 53 of 88 (60.2%) women.
Mental well-being was defined by the Optum SF-36v2 mental component summary; below 40 was poor, 40 or above normal. 24 cases had impaired well-being, 64 controls normal.
Measures at baseline and 6 months: visual analogue scales, NOSE, SNOT-22, Likert scales, plus nasal peak inspiratory flow, airway resistance, and minimum cross-sectional area.
Visual analogue scale improved by a mean 18 points on the left and 24 on the right, both P below .001.
NOSE improved by a mean 1.35 and SNOT-22 by 0.81, both P below .001.
Nasal peak inspiratory flow improved by a mean 32 L/min, P below .001.
Nasal airway resistance and minimum cross-sectional area did not change; patients with poor mental health had similar improvements to controls. Level of evidence 3.

What it means for a patient

Poor mental well-being before surgery did not predict a worse breathing result here.
Airflow measured at peak inspiration improved, while resistance and the narrowest cross-section did not, so the objective measures did not all agree.
This concerns breathing outcomes only, not satisfaction with appearance.
Limits: 88 patients across two centers, 6 month follow-up, unequal group sizes of 24 and 64, and mental well-being assessed by a general health survey rather than a psychiatric assessment.

Why this paper matters

Concerns about mental health are often raised when selecting rhinoplasty patients, and this separates the functional question from the cosmetic one. The finding argues against withholding functional surgery on mental health grounds. It does not address satisfaction with appearance, where the association is better documented.

Terms

Case-control study: A design comparing a group with a characteristic against a group without it.
SF-36 mental component summary: A general health survey score summarizing mental well-being.
NOSE scale: The Nasal Obstruction Symptom Evaluation, a validated blockage questionnaire.
SNOT-22: A 22-item questionnaire covering nasal and sinus symptoms.
Nasal peak inspiratory flow: The maximum airflow achieved breathing in through the nose.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Mental health can have an impact on patient satisfaction with rhinoplasty. However, the association between mental health and patient satisfaction with functional outcomes of rhinoplasty is poorly understood.

Objective: To determine whether preoperative mental health is associated with satisfaction with functional outcomes of rhinoplasty.

Design, Setting, And Participants: This case-control study assessed baseline nasal function and postsurgical functional outcomes for 88 consecutive patients undergoing rhinoplasty with both cosmetic and functional goals at 2 tertiary rhinologic centers in Sydney, Australia.

Exposures: Poor mental well-being was defined preoperatively by the Optum SF-36v2 Health Survey mental component summary.

Main Outcomes And Measures: Nasal function was assessed with patient-reported outcome measures, including visual analog scales, the Nasal Obstruction Symptom Evaluation Scale (NOSE), the 22-item Sinonasal Outcome Test (SNOT-22), and Likert scales. Objective outcomes included nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. All outcomes were assessed preoperatively and 6 months postoperatively. The 36-item Optum SF-36v2 Health Survey mental component summary was used to assess mental well-being, with a score of less than 40 indicating poor mental well-being and a score 40 or higher indicating normal well-being.

Results: Mean (SD) patient age was 37.6 (12.9) years and 53 of 88 (60.2%) were women. The mental component summary defined impaired well-being in n = 24 (cases) and normal well-being in n = 64 (controls). There were improvements in the total study population across most nasal function outcomes and in both groups. After rhinoplasty, benefit was seen for both groups in visual analog scale (left side mean [SD] change, 18 [30]; P < .001 and right side mean [SD] change, 24 [30]; P < .001); NOSE (mean [SD] change, 1.35 [1.21]; P < .001); and SNOT-22 (mean [SD] change, 0.81 [0.88]; P < .001) scores. Nasal peak inspiratory flow improved for both groups (mean [SD] change, 32 [45] L/min; P < .001), while nasal airway resistance and minimum cross-sectional area remained similar (change in nasal airway resistance, 0.086 Pa/cm3/s; 95% CI, -0.007 Pa/cm3/s to 0.179 Pa/cm3/s and change in minimum cross-sectional area, -0.04 cm2; 95% CI, -0.21 cm2 to 0.13 cm2). Patients with poor mental health had similar improvements in nasal function compared with controls.

Conclusions And Relevance: Rhinoplasty imparts similar benefits to nasal function assessed by patient-reported outcome measures and objective airflow measures regardless of preoperative mental health status.

Level Of Evidence: 3.

Abstract as indexed by PubMed; the article is open access (PubMed Central).