JOURNAL ARTICLE

The effects of alar batten grafts on nasal airway obstruction and nasal steroid use in patients with nasal valve collapse and nasal allergic symptoms: a prospective study

Ahmed S Sufyan, Emily Hrisomalos, Mimi S Kokoska, Taha Z Shipchandler
JAMA Facial Plastic Surgery 2013, 15 (3): 182-6
23450346

IMPORTANCE: Clinical management of nasal airway obstruction (NAO) in patients with and without nasal allergic symptoms and nasal valve collapse (NVC).

OBJECTIVE: To examine the impact that autologous alar batten grafts have on patients with NAO owing to NVC and their affect on nasal steroid use and allergic symptoms.

DESIGN: A prospective study.

SETTING: Indiana University Medical Center, Indianapolis.

PARTICIPANTS: Patients with NAO due to NVC with or without symptoms of nasal allergic symptoms.

INTERVENTIONS: All of the patients had placement of autologous batten grafts during the study period.

STUDY SELECTION: Prospective study of patients with dynamic NVC undergoing alar batten graft treatment.

DATA EXTRACTION: Nasal Obstruction Symptom Evaluation survey preoperatively and postoperatively, prospective outpatient questionnaire to determine use of nasal steroids and presence of nasal allergic symptoms preoperatively and postoperatively.

RESULTS: A total of 126 patients underwent surgical intervention for the treatment of NAO due to NVC. All of these patients were using nasal steroid sprays, and 78 patients (62%) also reported nasal allergic symptoms at their initial presentation. At 6-month and 1-year postoperative evaluations, 118 (94%) and 122 (97%), respectively, reported significant improvement of their NAO, regardless if they had presented with or without allergic nasal symptoms. Sixty-two of the 78 patients (79%) who initially presented with NAO owing to NVC and nasal allergic symptoms preoperatively reported significant improvement in their NAO and nasal allergic symptoms postoperatively. Eight of 126 (6%) restarted their use of nasal steroids postoperatively. All 8 of these patients reported nasal allergic symptoms preoperatively. No patients in the nonallergic group continued the use of nasal steroids postoperatively. There was no increase in nasal steroid use at the 12-month follow-up visit.

CONCLUSIONS AND RELEVANCE: Nasal airway obstruction due to NVC in patients can be surgically treated with autologous alar batten grafts. In addition, the use of alar batten grafts may improve NAO in patients with nasal allergic symptoms and reduces their use of nasal steroids. These results support the idea of potential surgical repair of the nasal valve to treat patients with NAO due to nasal allergic symptoms and NVC.

LEVEL OF EVIDENCE: 4.

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