LAUSR

We read the article titled “Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial” by Dadgarnia et al. [1] with interest. Nasal packing after septoplasty has been used to approximate the septal mucoperichondrial flaps mechanically, to prevent bleeding and septal hematoma, to support the septum, to stabilize the repositioned cartilage and bone fragments, and to prevent synechiae between the septum and lateral nasal wall [2–4]. However, nasal packing can cause severe pain and trigger marked patient anxiety. In recent years, transseptal suturing has been developed as an alternative to packing [5]. Such suturing reduces the pain and anxiety caused by respiratory problems or packing removal [6]. Most previous studies have compared the efficacy and complications of nasal packing and trans-septal suturing after septoplasty. Dadgarnia et al. [1] were the first to evaluate nasal air flow and resistance using rhinomanometry; they concluded that using trans-septal sutures after septoplasty might be associated with lower frequencies of several specific complications and a lower rate of patient discomfort than nasal packing. However, the trans-septal group had an increased risk of bleeding and hematoma. No differences were observed in nasal air flow and resistance between the two groups. This is excellent work. However, the sample number was small and the follow-up time was short; more details and longer follow-up are needed. Dadgarnia et al. [1] wrote, “Patients with deviated nasal septum who were candidates for septoplasty were recruited. Patients were randomly assigned to two groups. Due to properties of study interventions, it was not possible to perform either a single-blind or double-blind trial. Patients with history of allergic rhinitis, nasal polyps, or complete obstruction of a nostril due to deviated nasal septum were excluded. All subjects underwent septoplasty.” They did not compare the preoperative type and severity of nasal septal deviation (NSD). NSD has been divided into six types [7–9] and previous research has shown that the type of NSD can affect the outcome and complications of septoplasty. Eren et al. [8] compared postoperative success and patient satisfaction among patients with septum deviation according to the deviation type using a visual analog scale (VAS), the Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), rhinomanometry (RMM), and peak nasal inspiratory flow (PNIF). They found that the AR values of narrow cavities in all groups increased postoperatively, but this increase was observed only for wider cavities in types 2, 4, and 6. The RMM values were higher for the narrow cavities in types 2, 4, and 6 postoperatively, whereas only types 4 and 6 had higher values for the wider cavities. Dogan et al. [9] evaluated the nasal mucociliary transport rate according to NSD type and found that although the postoperative nasal mucociliary transport rate and clearance rates were increased compared with the preoperative values in all groups, the increase was significant only in types 2, 4, and 6. The postoperative half-time increased significantly compared with the preoperative values in types 2, 4, and 6. Berkiten et al. [10] analyzed the influence of NSD type on nasal mucociliary clearance, quality of life, olfactory function, and efficiency of septoplasty with or without inferior turbinate reduction and partial middle turbinectomy and found that the mean saccharin clearance time (SCT) of the convex sides did not differ, but that of the concave sides differed in types 3, 4, 5, and 6, which had a prolonged SCT (P < 0.05). Additionally, nasal air flow and resistance was This comment refers to the article available at https://doi. org/10.1007/s00405-017-4664-y.