Author(s)
Eric X. Wei, MD
Allen Green, BS
Cherian Kandathil, MD
Sam P. Most, MD
Affiliation(s)
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, Stanford Health Care, 801 Welch Road, Palo Alto, CA 94304
Abstract:
Background:
Nasal valve collapse (NVC) is a common cause of nasal airway obstruction, with substantial morbidity. Recently, a major insurer instituted a policy stating that valve repair would not be authorized unless prior septoplasty had been performed. Here we explore whether prior septoplasty in patients with likely NVC is associated with an increased risk of requiring extranasal rib/ear cartilage grafts among patients who subsequently undergo NVC repair procedures.
Learning Objectives:
Understand how prior septoplasty in patients with NVC impacts risk of extranasal cartilage grafts in subsequent NVC repair procedures.
Study Objectives:
Compare rates of rib or ear cartilage grafts in NVC repair procedures in patients with or without prior septoplasty.
Design Type:
Retrospective Cohort Study
Methods:
Insurance claims data were obtained from the Merative™ Marketscan® Research Databases, 2007-2021. We isolated patients who underwent RNVS as a proxy for NVC and determined whether they underwent a rib and/or ear cartilage graft concurrently. T-tests and chi-squared tests were performed.
Results:
Among 13,895 patients who underwent RNVS, 1,591 (11.5%) required an extranasal cartilage graft. Patients who underwent isolated septoplasty with or without inferior turbinate reduction (ITR) prior to their RNVS surgery were more likely to require an extranasal graft during their RNVS procedure than patients with no prior history of isolated septoplasty (23.1 vs 11.2%; p<0.001)
Conclusions:
Our findings suggest that patients who present with NVC would benefit from complete treatment initially, such as RNVS and septoplasty +/- ITR, rather than trying to correct nasal obstruction using septoplasty +/- ITR without RNVS.