The Effect of Functional Rhinoplasty on Quality of Life: A Systematic Review and Meta-Analysis

Overview

Functional rhinoplasty is nose surgery performed mainly to improve breathing. The authors set out to review its effect on quality of life comprehensively. They searched PubMed, Ovid and Embase for eligible studies published before December 2022 and pooled the results with Stata, using four outcome instruments.

Sections of note

• Design: systematic review with meta-analysis. Level of evidence III.
• 16 studies including a total of 971 patients were pooled.
• Outcomes examined: NOSE score, SNOT-22 score, a visual analog scale for obstruction, and the Rhinoplasty Outcome Evaluation.
• Functional rhinoplasty statistically reduced NOSE scores, SNOT-22 scores and the obstruction visual analog scale, where lower means better.
• It statistically increased Rhinoplasty Outcome Evaluation scores, where higher means better.
• The authors note the number and quality of included studies as a limitation and call for larger, higher quality studies.
• No pooled effect sizes, confidence intervals or heterogeneity figures appear in the abstract.

What it means for a patient

• Across the published evidence, patients report better breathing and better quality of life after surgery done for breathing reasons.
• Four different questionnaires all moved in the same direction, which is a consistent signal.
• The abstract gives no numbers for how large the improvement was, so the practical size of the benefit cannot be judged from it.
• Limits: the studies pooled were mostly single group before and after designs, with no control group, so natural change and placebo effects are not separated out.

Why this paper matters

Functional rhinoplasty is often the part of nose surgery that insurers scrutinize, and evidence that it improves daily life bears directly on that. Pooling 971 patients gives more weight than any single series. The absence of controlled trials means the size of the true effect remains uncertain.

Terms

• Functional rhinoplasty: nose surgery performed mainly to improve breathing.
• Meta-analysis: statistical pooling of results from multiple studies.
• NOSE score: a questionnaire measuring nasal blockage, where higher means worse.
• SNOT-22: a 22 item questionnaire measuring sinus and nasal symptoms and their impact.
• Rhinoplasty Outcome Evaluation: a patient questionnaire scoring satisfaction with the nose.
• Quality of life: how much a condition affects daily functioning and wellbeing.