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Letters to the Editor

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October 31, 2015
by Satvinder Singh Bakshi, MS, DNB; Raman Wadhera; Naushad Zafar; Sat Paul Gulati; Vijay Kalra; Anju Ghai

Dear Editor:

This letter is in reference to an interesting study, “Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery,” by Wadhera et al published in your esteemed journal.1 The study is interesting and useful, and I would like to commend the author and his colleagues. However, there seem to be some shortcomings in the methodology, which I would like to highlight.

The authors have compared two different methods of postoperative care and have concluded that nasal splints are more useful than conventional nasal packing in postop septoplasty cases. In another study published in your journal, it has already been proven that nasal packing after septoplasty is unnecessary and adds only more discomfort to the patient.2 Therefore, comparing splints with nasal packing does not seem to be appropriate. A better methodology would be to compare splint versus no splint postoperatively so that a better conclusion can be drawn.

Although septoplasty is a common surgery, the results depend on the experience of the surgeon, as well as on the grading and type of deviation before surgery.3 In the Wadhera study, these factors were not taken into account before the patients were divided into groups since this could have resulted in a treatment bias that could have influenced the results. Nevertheless, the people analyzing the results were not blinded, which might have resulted in an observer bias, again influencing the results.

The best way forward would be to design a blinded, randomized study comparing nasal splints versus no splints after septoplasty, with preoperative matching of the groups for age, type and degree of deviation, and other factors that might influence the results.

Response:

We appreciate the queries raised by Dr. Bakshi in response to our article. The following are our comments regarding points raised by Dr. Bakshi.

First, nasal packing is still being done by many ENT surgeons in our country, and intranasal septal splints are not being used routinely. That prompted us to evaluate the role of intranasal septal splints and to compare the results of this type of treatment with those of conventional nasal packing.

Second, regarding the grading and type of deviation, only those patients who had severe deviation of the nasal septum were included in our study. All the patients were operated on by the first and third authors, who had more than 15 years of experience after their postgraduate education. In the “Patients and methods” section of our article, it was mentioned that we only chose those patients who had symptomatic nasal deviation. After that, patients were randomly divided into two groups.

Finally, the people analyzing the results could not be blinded, as it was not practical in our study. It was obvious in the first 48 hours whether a patient belonged to the packing group or the splint group, as nasal packs were clearly visible. Nasal packs were removed after 48 hours, and septal splints were removed after 1 week. Anterior ends of the splints were easily visible in the nasal vestibule, so even after removal of the nasal packs, it was obvious at first follow-up (first week) whether a patient belonged to the packing or the splint group.

Regards,



References

  1. Wadhera R, Zafar N, Gulati SP ,et al. A comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery. Ear Nose Throat J 2014; 93 (9): 396-408.
  2. Awan MS, Iqbal M. Nasal packing after septoplasty: A randomized comparison of packing versus no packing in 88 patients. Ear Nose Throat J. 2008; 87 (11): 624-7.
  3. Godley FA. Nasal septal anatomy and its importance in septal reconstruction. Ear Nose Throat J 1997; 76 (8): 498-501, 504-6.
Department of ENT and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
Department of Otorhinolaryngology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Department of Anaesthesiology, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Ear Nose Throat J. 2015 October-November;94(10-11):E50