Effectiveness of septoplasty.

Rationale:

Surgical correction of a deviated nasal septum (septoplasty) is the most common ENT operation in adults in the Netherlands. Indications for this intervention are practice-based rather than evidence-based and internationally accepted guidelines are lacking. Subsequently, the Dutch rate of septoplasties appears to be higher than that in most other Western countries.



Objective:

What is the effectiveness of septoplasty compared to a watchful waiting strategy in adults in terms of health related quality of life and nasal passage? What is the relation between costs and effects of this procedure?

Which patients benefit most from the operation?



Study design:

Open multi-centre randomized controlled trial.



Study population:

Two hundred adults selected for septoplasty according to current medical practice.



Intervention:

Septoplasty performed within 6 weeks after randomization versus a non-surgical or watchful waiting strategy.



Follow-up:

Two years including symptom and cost diaries and scheduled follow-up visits at 0, 3, 6, 12 and 24 months.



Primary outcome measure:

Health related quality of life.



Secondary outcome measures:

Objective measurement of nasal patency, symptoms score, and costs.



Data analysis:

Effects will be calculated as incidence rate differences and incidence rate ratios, with 95% confidence intervals. Quality of life data will be analyzed with Student T- tests and analyses of variance (ANOVA). All analyses will be performed on an intention-to-treat basis. Costs per QALY will be estimated. Incremental cost-effectiveness ratios with 95% CIs will be calculated, and a budget impact analysis will be performed.

Nasal obstruction is one of the most common reasons for nasal surgery and a deviated nasal septum is the most common anatomical cause of nasal obstruction. Accordingly, septal surgery is one of the most common procedures in ENT practice. There is an urgent call for such guidelines. Both the UK and Dutch ENT-societies recently indicated the 'effectiveness of septoplasty' as one of their most important gaps in medical knowledge. The objective of the current proposal therefore is to study the effects of septoplasty as compared to watchful waiting.

1. Baseline;

2. 3 months;

3. 6 months;

4. 12 months;

5. 24 months.

Septoplasty, i.e. surgical correction of a deviated nasal septum according to the current medical practice. The control group will be a watchfull waiting strategy.