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Self Perception of Nasal Function

NEW YORK (Reuters Health) - Poor self-perception of nasal function is associated with poor mental health status, according to a cross-sectional study at two rhinoplasty centers in Australia.

"It is no secret that mental well-being has the potential to affect how a person sees themselves - in their capacity to work or study, their relationships, and their health,” Erika Strazdins from University of New South Wales in Sydney told Reuters Health by email. “This research is interesting as it provided evidence that the effect of mental well-being on perception may extend to physiological functions that the person has little control over - like their ability to breathe.”

Previous studies have yielded conflicting results regarding the psychological aspects of rhinoplasty, but it seems clear that some psychological abnormalities (body dysmorphic disorder (BDD), anxiety, and depression) are overrepresented in patients undergoing rhinoplasty.

Little is known, however, about the relationships between mental disorders and perception of nasal function.

Strazdins’s team investigated whether mental health status, as determined by mental well-being, self-esteem, and dysmorphic concerns, is associated with baseline perception of nasal function when compared with objective airflow analysis in their study of 495 patients with functional and cosmetic indications for rhinoplasty who underwent nasal airflow analysis.

Based on results from the Rosenberg Self-Esteem Scale, the Mental Component Summary score from the Short Form Health Survey (SF36), and the Dysmorphic Concerns Questionnaire, 70.7% of patients had healthy mental well-being, 93.1% had healthy self-esteem, and 77.2% had healthy dysmorphic concerns.

Patients with poor mental well-being perceived their nasal function as significantly worse in all patient-reported outcome measures, including sensation of nasal obstruction, severity of nasal obstruction symptoms, and nasal function anchor score, compared with patients who had healthy well-being, according to the July 20th JAMA Facial and Plastic Surgery online report.

Objectively, though, nasal function did not differ clinically between patients with poor mental well-being and those with good mental health.

Patients with low self-esteem also perceived their nasal function as poorer, compared with that of patients with healthy self-esteem, but small differences in airflow analysis between the groups were not felt to represent true differences in nasal function.

Dysmorphic concerns were not significantly related to any patient-reported outcome pertaining to nasal function, which was objectively similar between patients with healthy and with high levels of dysmorphic concerns.

“Difficulties in breathing can have a lasting and frustrating impact on a person’s life, affecting their ability to exercise, sleep, and eat,” Strazdins said. “Should a patient be complaining about poor nasal function despite having normal parameters on objective testing, it would be valuable to counsel them that the surgical outcomes may be less beneficial than they expect. This could help to inform them in their decision to undergo surgery and also have realistic expectation of the outcome.”

“This is an important consideration for surgeons as patients may seek medical attention and pursue treatments based on these perceptions,” she added. “Personally, this serves as a reminder to overcome a challenge of increasing specialization in surgery - to see the patient as a whole with their physical, mental, and social health.”

Dr. Abel-Jan Tasman from Kantonsspital St. Gallen, Switzerland, who wrote an invited commentary related to this report, told Reuters Health by email, "I would have expected the result, seeing many patients with vague breathing issues, that are often felt to be ‘obstruction.’ Surprising may be the general unawareness of anxiety as a contributing factor.”

“Surgery performed well almost always improves breathing, even in patients with psychologic comorbidities,” he said. “From anecdotal evidence, anxiety may be relieved to a certain degree. No hard evidence here from what I know. It is important to make the patients aware of aspects that are not amenable to the surgeon's blade.”

Dr. Lisa E. Ishii from Johns Hopkins University, Baltimore, Maryland, who coauthored a clinical practice guideline regarding nasal form and function after rhinoplasty, told Reuters Health by email, "It is actually very common for patients to experience nasal obstruction in the setting of objective testing that is normal. We do not understand fully why this occurs but it occurs frequently.”

“This is a pilot study that should be repeated with larger studies before we should consider changing practice,” she said. “It suggests that having an appreciation for patients' mental wellness may be important when evaluating them and planning their treatment.” To find out if you are a candidate for rhinoplasty, please contact our office today at 504-226-8200 to book your consultation.