Effects of Functional Rhinoplasty on Nasal Obstruction: A Meta-Analysis

Zhao R, Chen K, Tang Y.

PubMed 35099579 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 43 studies covering 2,024 patients, functional rhinoplasty improved nasal obstruction scores by about 43 to 48 points at every follow up point out to a year.

Overview

Functional rhinoplasty improves nasal airflow by correcting problems with the nasal valves, and had not previously been reviewed on a large scale. A comprehensive search of PubMed, EMBASE and the Cochrane Library identified studies measuring nasal obstruction before and after this surgery in patients with nasal valve problems.

Sections of note

Meta analysis of 57 cohorts from 43 studies involving 2,024 patients; the journal assigns level of evidence III.
NOSE scores improved by a weighted mean difference of 38.12 at 1 month, 48.40 at 3 months, 44.35 at 6 months and 43.07 at 12 months, all P equals 0.00.
At last follow up the improvement was 46.90, 95 percent confidence interval 43.92 to 49.88.
Visual analogue scale scores showed the same trend, improving 4.68 at 1 month, 4.46 at 3 months, 4.91 at 6 months and 4.22 at last follow up.
Rhinomanometry showed significant relief of obstruction, standardized mean difference 0.56, with no heterogeneity, I squared equals 0.0 percent.
Peak nasal inspiratory flow did not show significant improvement, standardized mean difference minus 1.51, P equals 0.09.
Heterogeneity was high for most patient reported outcomes, reaching I squared of 97.9 percent at 12 months.

What it means for a patient

Patients consistently reported large improvements in nasal breathing, sustained through a year of follow up.
One objective airflow test agreed, but the other, peak flow, did not.
Heterogeneity near 98 percent means the included studies disagreed substantially, weakening the pooled figures.
The authors state broader and better designed studies are needed.

Why this paper matters

Functional rhinoplasty is performed to treat blocked breathing, and whether patient reported gains match objective airflow measurement has been contested. This is the largest pooled assessment of that question. The disagreement between the two objective tests is left unresolved.

Terms

Functional rhinoplasty: nasal surgery performed to improve breathing rather than appearance.
Nasal valve: the narrowest part of the nasal airway, where airflow is most restricted.
NOSE score: the Nasal Obstruction Symptom Evaluation, where lower is better.
Rhinomanometry: a test measuring pressure and airflow through the nose.
Peak nasal inspiratory flow: the maximum airflow during a forced sniff.
Weighted mean difference: the pooled average change across studies.

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

Abstract

Background: Functional rhinoplasty (FRP) is used to improve nasal ventilation by correcting problems with the nasal valves. It has not been systematically reviewed on a large scale.

Methods: A comprehensive literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases to identify studies evaluating nasal obstruction before and after functional rhinoplasty in patients with nasal valve problems.

Results: A total of 57 cohorts from 43 studies involving 2024 patients were included in the current meta-analysis. The Nasal Obstruction Symptom Evaluation (NOSE) scores indicated significant improvement in nasal obstruction at the 1-month follow-up (WMD = 38.12; 95% CI, 29.15-47.10; I2 = 83.6%; P = 0.00), 3-month follow-up (WMD = 48.40; 95% CI, 43.16-53.64; I2 = 69.1%; P = 0.00), 6-month follow-up (WMD = 44.35; 95% CI, 36.65-52.04; I2 = 96.6%; P = 0.00), 12-month follow-up (WMD=43.07; 95% CI, 26.56-59.58; I2 = 97.9%; P = 0.00), and the last follow-up (WMD = 46.90; 95% CI, 43.92-49.88; I2 = 95.9%; P = 0.00) with respect to the preoperative baseline. The Visual Analogue Scale (VAS) scores indicated a similar trend at the 1-month follow-up (WMD = 4.68; 95% CI, 3.79-5.57; I2 = 86.8%; P = 0.00), 3-month follow-up (WMD = 4.46; 95% CI, 3.19-5.74; I2 = 93.3%; P = 0.00), 6-month follow-up (WMD = 4.91; 95% CI, 4.04-5.78; I2 = 88%; P = 0.00) and last follow-up (WMD = 4.22; 95% CI, 3.12-5.32; I2 = 97.1%; P = 0.00). Nasal obstruction was obviously relieved through rhinomanometry (SMD=0.56; 95% CI, 0.27-0.84; I2 = 0.0%; P = 0.00) but not through peak nasal inspiratory flow (PNIF) (SMD=-1.51; 95% CI, -3.10 to 0.07; I2 = 98.9%; P = 0.09).

Conclusion: FRP may have a positive effect on nasal obstruction caused by nasal valve problems. Broader and well-designed studies are needed to shed more light on the relationships in this area.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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