Journal Reading

The Effect of Tobacco

Smoking on Septoplasty
Outcomes : A Prospective
Controlled Study
Read by :
dr. Adi Matra Prawira

Supervisor
Prof. Dr. dr. Abdul Qadar Punagi, Sp.T.H.T.K.L(K),FICS
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“Smoking, active or passive,

has been related to several
Introduction diseases of the human
respiratory system
.

“the effects of smoking on upper

respiratory system surgeries have
not been widely evaluated
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○ “risk factor for sinonasal

carcinoma, nasal polyposis,
Introduction and sinusitis, and in children
for the development of otitis
media .

○ “Thousands of chemicals in
tobacco smoke affect ciliary
function in the respiratory tract
 “
When a cigarette burns it
releases a dangerous cocktail
of over 5,000 different
chemicals. Many of these
chemicals are poisonous and
more than 70 may cause
cancer (IARC)

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 Sidestream smoke is about 4 times more toxic than mainstream
smoke, although people inhale it in a more diluted form, because
contains much higher levels of many of the poisons and cancer-
causing chemicals in cigarettes, including:

1. At least 3 times as much carbon monoxide

2. 10-30 times more nitrosamines
3. Between 15–300 times more ammonia

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 “Septoplasty is one of the 8

most common and earliest

learned surgical procedures
in otolaryngology practice
Introduction
“one-third of the population has
some nasal obstruction and 25% of
them require a surgical operation

“Previous studies have shown that the surgery

results are affected by many different factors
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Introduction “we evaluated the effects

of smoking on functional
outcomes and
complication rates in
septoplasty
 MATERIALS AND METHOD
A prospective study was performed at the department of
Otolaryngology of Bakirköy Training and Research Hospital,
between January 2012 and December 2013
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Patients with nasal obstruction and

were diagnosed to have septal
deviation underwent septoplasty

MATERIALS AND METHOD (Study Subject)

Inclusion criteria : ≥ 18 years, presence of septal

deviation, and the presence
of persistent symptoms
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Exclusion criteria : < 18 years, cessation of
smoking, asthma/allergic rhinitis, turbinate
hypertrophy, chronic sinusitis –
rhinitis, previous nasal surgery,
and septal deviation.
MATERIALS AND METHOD (Study Subject)

ex-smokers, or changed their smoking

habits (ceased, increased, or decreased)
during the study period
 Group A
Non - smokers

Group B
Subject
Light Smokers

Group C
Heavy Smokers
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 Evaluated for Excluded :
Eligibilty (n = 248) • Not willing to join (n = 14)
• Self reported asthma / 14
rhinitis allergic (n = 24)
• Previous nasal surgery
Randomised (n = 7)
• Lost to follow up (n :8)
(n = 195)

Group A (n = 65) Group B (n = 65) Group C (n = 65)

Non - Smokers Light Smokers Heavy Smokers

Lost to Follow Up ( Lost to Follow Up Lost to Follow Up

n = 3) (n = 4) (n = 5)

Analysed (n = 62) Analysed (n = 61) Analysed (n = 60)

Table : The consort diagram of the study evaluating the effect of smoking on septoplasty outcomes
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Table : Nasal Obstruction Symptom Evaluation (NOSE) scoring to
evaluate the negative effects of smoking on septoplasty outcomes

A B C D E

Nasal Congestion or stuffiness 0 1 2 3 4

Nasal Blockage or obstruction 0 1 2 3 4

Trouble Breathing Through The Nose 0 1 2 3 4

Trouble Sleeping 0 1 2 3 4
Unable to Get Enough Air Through The Nose
0 1 2 3 4
During Exercise or Extension

A : Not A Problem D : Fairly Bad Problem

B : Very Mild Problem E : Severe Problem
C : Moderate Problem
 “Subgroup comparisons 16

were performed using

Dunn’s multiple
Material
comparison test
and Method
“qualitative comparisons of
data were performed using
the χ2 test

“qualitative data on recurrence were

evaluated with McNemar’s test
RESULT

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Table: The comparison of NOSE scores between study groups (Group A: Non smokers, Group
B: Light smokers (<20 cigarettes per day), Group C: Heavy smokers (>20 cigarettes per day)

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Table : The comparison of NOSE Alterations (%) between study groups(Group A: Non
smokers, Group B: Light smokers (<20 cigarettes per day), Group C: Heavy smokers
(>20 cigarettes per day).

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Table : The detected complications at 1th month and 6th month visit according to
study groups (Group A: Non smokers, Group B: Light smokers (<20 cigarettes
per day), Group C: Heavy smokers (>20 cigarettes per day).

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 20

15

Non - Smokers
10 Light Smokers
Heavy Smokers
5

0
1st Month 6th Month Total

Chart : Comparison of complication rates according to the groups (Group A: Non smokers, Group B: Light
smokers (<20 cigarettes per day), Group C: Heavy smokers (>20 cigarettes per day). 21
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Kjaergaard et al evaluated 2,523 subjects 24
who sought medical care for upper
respiratory system problems. They
evaluated the effects of smoking on self-
reported upper airway health.

Rudmik et al reported that active smoking

status (500 non-smokers and 33 smoking
subjects, who had similar preoperative
Lund-Mackay scores) did not alter
postoperative recovery in QOL after
endoscopic sinus surgery

However, another study found that cigarette

smoking affected the long-term outcomes of
endoscopic sinus surgery.
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We performed this prospective study to evaluate the

effects of smoking on septoplasty outcomes

We used the NOSE scale to study the effects of

smoking on septoplasty outcomes.

smoke exposure will be highly variable because of the

differences in nicotine contents of cigarettes, the smoking
environment, and mainstream versus sidestream smoke
 “
We did not find any significant
differences between heavy or
light smoking and non-smoking
subjects in NOSE scores or
complications

We also advised our patients to

quit smoking for its known
harmful effects

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