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Nasal Airway Obstruction Study (NAIROS): a phase III, open label, mixed methods, multicentre randomised controlled trial of septoplasty versus medical management of a septal deviation with nasal obstruction

Lookup NU author(s): Dr Kate Rennie, Dr Nikki Rousseau, Dr Deborah Stocken, Denise Howel, Dr Laura Ternent, Dr Michael Drinnan, Dr Alison Bray, David Hamilton, Dr Alison Steel, Tony Fouweather, Dr Ann Marie Hynes, Dr Eva-Maria Holstein, Dr Yemi Oluboyede, Dr Alaa Abouhajar, Professor Janet Wilson, Sean Carrie

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

BACKGROUND: Septoplasty (surgery to straighten a deviation in the nasal septum) is a frequently performed operation worldwide, with approximately 250,000 performed annually in the US and 22,000 in the UK. Most septoplasties aim to improve diurnal and nocturnal nasal obstruction. The evidence base for septoplasty clinical effectiveness is hitherto very limited. AIMS: To establish, and inform guidance for, the best management strategy for individuals with nasal obstruction associated with a deviated septum. METHODS/DESIGN: A multicentre, mixed-methods, open label, randomised controlled trial of septoplasty versus medical management for adults with a deviated septum and a reduced nasal airway. Eligible patients will have septal deflection visible at nasendoscopy and a nasal symptom score ≥ 30 on the NOSE questionnaire. Surgical treatment comprises septoplasty with or without reduction of the inferior nasal turbinate on the anatomically wider side of the nose. Medical management comprises a nasal saline spray followed by a fluorinated steroid spray daily for six months. The recruitment target is 378 patients, recruited from up to 17 sites across Scotland, England and Wales. Randomisation will be on a 1:1 basis, stratified by gender and severity (NOSE score). Participants will be followed up for 12 months post randomisation. The primary outcome measure is the total SNOT-22 score at 6 months. Clinical and economic outcomes will be modelled against baseline severity (NOSE scale) to inform clinical decision-making. The study includes a recruitment enhancement process, and an economic evaluation. DISCUSSION: The NAIROS trial will evaluate the clinical effectiveness and cost-effectiveness of septoplasty versus medical management for adults with a deviated septum and symptoms of nasal blockage. Identifying those individuals most likely to benefit from surgery should enable more efficient and effective clinical decision-making, and avoid unnecessary operations where there is low likelihood of patient benefit. TRIAL REGISTRATION: EudraCT: 2017-000893-12, ISRCTN: 16168569. Registered on 24 March 2017.


Publication metadata

Author(s): Rennie KJ, OHara J, Rousseau NS, Stocken DD, Howel D, Ternent L, Drinnan M, Bray A, Rooshenas L, Hamilton DW, Steel A, Fouweather T, Hynes A-M, Holstein E-M, Oluboyede Y, Abouhajar A, Wilson JA, Carrie S

Publication type: Article

Publication status: Published

Journal: BMC Trials

Year: 2020

Volume: 21

Issue: 1

Online publication date: 13/02/2020

Acceptance date: 16/01/2020

Date deposited: 24/02/2020

ISSN (electronic): 1745-6215

Publisher: BMC

URL: https://doi.org/10.1186/s13063-020-4081-1

DOI: 10.1186/s13063-020-4081-1


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