SynthesisEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2025
Nasal surgery is pivotal, not primary, in OSA surgery - a 25-year evidence based systematic review.
Synthesis in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate the contribution of nasal surgery to multilevel OSA surgical success outcome.
methodsSystematic review of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA, nasal resistance, pharyngeal volume/space, nasal surgery, multilevel surgery and its outcomes. All relevant studies published between January 2000 to December 2024 were included.
resultsTwelve studies were included in this systematic review with 11 articles illustrating that nasal surgery was pivotal, and improved outcomes in multilevel OSA surgery, whilst nasal surgery alone for OSA did not significantly affect polysomnographic results. Five articles utilizing CBCT, 3D measurements of nasal and pharyngeal airway area/volume, computational fluid dynamics and nasal resistance demonstrated that reducing nasal resistance with nasal surgery increased the pharyngeal airway space and volume; whilst 6 articles established through clinical case studies that multilevel OSA surgery combined with nasal surgery yielded better AHI, LSAT and ESS outcomes than multilevel surgery without nasal surgery. The landmark article that reviewed 24 years of nasal surgery alone for OSA treatment, showed poor outcomes and minimal AHI change with nasal surgery alone.
conclusionAs the upper airway is a continuous air conduit, reducing nasal resistance would reduce pharyngeal pressures leading to improvement of outcome parameters. Hence, including nose surgery in multilevel surgery improves surgical success. LEVEL OF EVIDENCE: 3:
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