Durability of Quality-of-Life Improvements in Pediatric Septorhinoplasty

Introduction: Septoplasty and functional septorhinoplasty are common surgeries in the adult population with excellent objective and quality-of-life outcomes. Their utility in children remains debated due to concerns over altered craniofacial growth—although delays in addressing nasal obstruction have also been shown to impact facial and dental growth. We previously showed improvement in quality-of-life metrics out to 4 months post-surgery in children undergoing functional nasal surgery. This study seeks to assess the long-term durability of those results.

Methods: Patients having septoplasty or septorhinoplasty by a single surgeon at an academic, free-standing children’s hospital between the years of 2013 and 2023 were prospectively enrolled in outcomes assessment using validated quality of life assessment tools—Nasal Obstruction Symptom Evaluation (NOSE) and Sinonasal 5 questionnaires—collected pre-operatively and at each post-operative visit. This database was then queried for assessment of outcomes based on changes in reported metrics. Statistical analysis was done in R (v.4.3.1) using paired T-tests.

Results: In total, 406 patients underwent surgery during this period. Follow-up rates were 98%, 32%, and 22% at 1, 6, and 12 months respectively. Ten percent of patients were seen at all three time points assessed. For all patients, the average pre-operative NOSE score was 67.1 (±22.2). These decreased to 15.9±17.3, 17.6±19.2, and 25.9±31.4 at 1, 6, and 12 months (p < 0.01). Pre-operative SN-5 scores were 3.4±1.2 and decreased to 1.9±1.1, 1.7±1.1, and 2.4±1.9 at 1, 6, and 12 months (p < 0.01). The VAS conversion of the SN5 was 5.1±2.3 pre-operatively and improved an average of 3.4±1.7 points at all time points (p < 0.01).

Conclusions: Functional nasal surgery in adolescent pediatric patients results in improvement in validated quality of life measures that are sustained over at least the first year following surgery. Loss to follow up in the patient population remains problematic in outcomes assessment and further, longer term outcomes assessment remains necessary.