LAUSR

We have read the article entitled ‘‘The effects of septoplasty surgery on serum oxidative stress levels’’, published by Ekinci et al. with great interest [1]. The authors compared TAS (total antioxidant status), TOS (total oxidant status), and PON1 (paraoxonase) serum levels in patients who have undergone septoplasty. Therefore, they found that there were a significant increase in TAS and decrease in TOS after septoplasty. This is a very interesting study and the first study to provide a hypothetical suggestion that patients with nasal septal deviation (NSD) are under oxidative stress that is relieved following septoplasty. However, we would like to make some comments concerning this hypothesis, based on literature review. First, we want to point out one minor authors’ mistake. The authors described that ‘‘The mean TOS decreased significantly after septoplasty (20.631 vs 5.946 mmol/L, p = 0.011)’’ in the abstract and the part of results. However, the p value (p = 0.011) was different from the p value described in Table 1 (p = 0.001). Which is right? Second, this study included 46 consecutive patients who had undergone septoplasty due to NSD. To prove their hypothesis, we think that there should be correlation between the severity of NSD and serum oxidative stress levels. However, they did not describe the measurement of the severity of NSD or the assessment of nasal obstruction in detail. Because of a lack of standardized objective criteria for making the diagnosis of NSD, physicians should keep in mind that there can be a significant inter-observer variability for verifying its precise location, quantifying the degree of deviation, and assessing its clinical impact on patients [2]. In addition, we should consider that the classification of septal deviation into type and severity using physical examination and CT cannot predict the degree of subjective nasal obstruction using validated visual analog scales (VAS) [3]. Third, although they excluded patients with various diseases and medical conditions, they did not mention about other conditions and diseases which can greatly influence serum oxidative stress levels such as metabolic syndrome, especially obesity. It is well known that metabolic syndrome is an obesity-associated collection of disorders and is also associated with oxidative stress which means overproduction of reactive oxygen species (ROS) [4]. Therefore, although they did not mention about the body weight of all participants, we suggest that it is important to measure the weight of all participants preoperatively and 3 months postoperatively.