Association of Mental Health Status With Perception of Nasal Function

Overview

Journal JAMA Facial Plast Surg

Publisher American Medical Association

Date 2017 Jul 21

PMID 28727888

Citations 2

Authors

Erika Strazdins

Yu Feng Nie

Raziqah Ramli

Tom Palesy

Jenna M Christensen

George Nicholas Marcells

Richard John Harvey

Affiliations

Soon will be listed here.

Abstract

Importance: Mental health issues are thought to be overrepresented among patients undergoing rhinoplasty and may be associated with patient presentation prior to surgery.

Objective: To assess the association of poor mental health with perception of nasal function.

Design, Setting, And Participants: A cross-sectional study of patients presenting for airway assessment was performed from December 1, 2011, to October 31, 2015, at 2 tertiary rhinoplasty centers in Sydney, Australia. Mental health was independently defined preoperatively by the Mental Component Summary of the 36-item Short Form Health Survey version 2 (a score of <40 indicated poor mental well-being), the Rosenberg Self-Esteem Scale (a score of <15 indicated low self-esteem), and the Dysmorphic Concerns Questionnaire (a score of >11 indicated above-average dysmorphic concerns).

Main Outcomes And Measures: Nasal function was assessed with patient-reported outcome measures, including the Nasal Obstruction Symptom Evaluation Scale, the 22-item Sinonasal Outcome Test, a visual analog scale to rate ease of breathing on the left and right sides, and Likert scales to assess overall function and nasal obstruction. Nasal airflow was assessed by nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area.

Results: Among 495 patients in the study (302 women and 193 men; mean [SD] age, 36.5 [13.6] years), compared with patients with good mental health, those with poor mental health had poorer scores in all patient-reported outcome measures, including the visual analog scale for the left side (mean [SD], 51 [25] vs 42 [25]; P = .001), visual analog scale for the right side (mean [SD], 54 [24] vs 45 [26]; P < .001), Nasal Obstruction Symptom Evaluation Scale (mean [SD], 2.64 [0.95] vs 1.96 [1.04]; P < .001), 22-item Sinonasal Outcome Test (mean [SD], 2.14 [0.84] vs 1.33 [0.83]; P < .001), nasal obstruction (58 of 145 [40.2%] vs 83 of 350 [23.7%] with severe or worse obstruction; P < .001), and nasal function (72 of 145 [49.7%] vs 111 of 350 [31.8%] with poor or worse function; P < .001). Subclinical differences in nasal peak inspiratory flow could be demonstrated, but all other nasal airflow measures were similar. Low self-esteem produced a similar pattern, but dysmorphia did not.

Conclusions And Relevance: Poor mental health status is associated with a poorer self-perception of nasal function compared with those who are mentally healthy with clinically similar nasal airflow. Clinicians should be aware that patients with poor mental health reporting obstructed airflow may in part be representing an extension of their negative emotions rather than true obstruction and may require further assessment prior to surgery.

Level Of Evidence: NA.

Citing Articles

Effectiveness of endoscopic intranasal incision reduction for nasal fractures.

Yan S, Jiang Y, Wang Y, Chen K, Yan X, Sun X Eur Arch Otorhinolaryngol. 2021; 279(3):1341-1348.

PMID: 34031750 PMC: 8897384. DOI: 10.1007/s00405-021-06878-3.

Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty.

Strazdins E, Nie Y, Ramli R, Palesy T, Christensen J, Alvarado R JAMA Facial Plast Surg. 2018; 20(4):284-291.

PMID: 29450446 PMC: 5876902. DOI: 10.1001/jamafacial.2018.0001.

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