Variation in Practice Patterns of Current Rhinoplasty Surgeons for Nasal Valve Compromise

Overview

The nasal valve is the narrowest part of the airway, and when it collapses it blocks breathing. A panel published clinical consensus statements on it in 2010. The authors tested whether practicing surgeons a decade later actually work that way. An online questionnaire based on those statements, scored on a 9-point Likert scale, was administered at the Advances in Rhinoplasty meeting.

Sections of note

• Design: cross sectional questionnaire survey at a single conference.
• Of 580 participants, 113 completed the survey.
• Most statements showed agreement between the original panelists and the surveyed surgeons.
• Fewer than 10 percent of responses met the criteria for discordance.
• Significant differences in practice appeared when responses were stratified by specialty, years in practice, geographic location, practice type and annual rhinoplasty volume.
• Disagreement concentrated on four diagnostic tools: diagnostic imaging, rhinoscopy, nasal endoscopy and acoustic rhinomanometry.
• The abstract does not report which way any specific group leaned.

What it means for a patient

• Surgeons largely agree on how to treat a collapsing nasal valve, but not on how to test for one before surgery.
• What tests you are offered may depend on your surgeon's specialty, training era, practice setting and location rather than on settled evidence.
• The response rate was low, 113 of 580 attendees, so the surveyed group may not represent all rhinoplasty surgeons.
• This survey records opinion and reported practice. It reports no patient outcomes.

Why this paper matters

Consensus statements are meant to standardize care, and testing whether they have been adopted is rarely done. The finding that agreement holds for treatment but breaks down over diagnosis points to where evidence is still missing. Which diagnostic approach actually improves outcomes is unanswered here.

Terms

• Nasal valve compromise: narrowing or collapse of the narrowest part of the nasal airway.
• Clinical consensus statement: agreed guidance produced by an expert panel.
• Likert scale: a response format where a rater chooses along a graded range of agreement.
• Nasal endoscopy: examining the inside of the nose with a lighted telescope.
• Acoustic rhinomanometry: measuring the nasal airway using reflected sound.
• Discordance: measured disagreement between two sets of responses.