The Effects of Nasal Airway Obstruction and Nasal Airway Surgery on Pulmonary Function: A Systematic Review and Meta-Analysis
Dr Gabriel Osie, ENT Registrar, Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Authors List
Osie, G. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Darbari Kaul, R. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Lindsay, B. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Farley, E. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Kalish, L. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney; Faculty of Medicine, University of Sydney, Australia
Campbell, R.G. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University; Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
Harvey, R.J. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
Introduction: Patients often report the experienced benefit of nasal breathing on their overall respiratory function. They also often report improvement of respiratory function after nasal airway surgery.
Aims: The impacts of both nasal obstruction and nasal airway surgery on pulmonary function were sought from published research.
Methods: A systematic review was performed for original research assessing pulmonary function in patients with nasal obstruction. Studies needed to compare the pulmonary function of patients with nasal obstruction to normal nasal airway controls, or compare pulmonary function in patients with nasal obstruction pre- and post-nasal airway surgery. The primary outcomes were percent-predicted forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), FEV1/FVC, tidal volume (mL), forced mid-expiratory flow (FEF25-75%), and peak expiratory flow rate (L/min) (PEFR). MEDLINE, EMBASE, Web of Science, Scopus, and CINAHL were searched from inception to May 6th 2025. A randomised effects model was used to predict pooled mean differences in patient groups with 95% confidence intervals.
Results: 9555 articles were identified with 27 included studies, comprising a total of 2142 patients. There was significantly impaired respiratory function in patients with nasal obstruction compared to patients with normal nasal function. Pooled mean differences for FEV1 was -8.21% [-12.22, -4.21] and FEF25-75% -5.02%[-7.36, -2.67]. Similar values were seen for FVC -4.46%[-9.41, 0.50], FEV1/FVC -3.42%[-7.83, 0.98], tidal volume -0.62mL[-41.95, 40.72], and PEFR -36.58L/min[-115.95, 42.80]. There was significant improvement in pulmonary function in nasally obstructed patients after nasal airway surgery. Pooled mean differences for FEV1 were 10.88%[5.05, 16.70], FVC 10.79%[4.87, 16.71], FEV1/FVC 1.28%[0.19, 2.38] and PEFR 52.31L/min[27.19, 77.43]. Similar values were seen for FEF25-75% 0.41[-0.01, 0.83].
Conclusion: Patients with nasal obstruction have a lower FEV1. Post-nasal airway surgery, improvements in FEV1, FVC, FEV1/FVC, and PEFR can be demonstrated. The meta-analysis suggests that nasal breathing and its restoration is physiologically advantageous for respiratory function.
Osie, G. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Darbari Kaul, R. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Lindsay, B. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Farley, E. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
Kalish, L. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney; Faculty of Medicine, University of Sydney, Australia
Campbell, R.G. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University; Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
Harvey, R.J. Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
Introduction: Patients often report the experienced benefit of nasal breathing on their overall respiratory function. They also often report improvement of respiratory function after nasal airway surgery.
Aims: The impacts of both nasal obstruction and nasal airway surgery on pulmonary function were sought from published research.
Methods: A systematic review was performed for original research assessing pulmonary function in patients with nasal obstruction. Studies needed to compare the pulmonary function of patients with nasal obstruction to normal nasal airway controls, or compare pulmonary function in patients with nasal obstruction pre- and post-nasal airway surgery. The primary outcomes were percent-predicted forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), FEV1/FVC, tidal volume (mL), forced mid-expiratory flow (FEF25-75%), and peak expiratory flow rate (L/min) (PEFR). MEDLINE, EMBASE, Web of Science, Scopus, and CINAHL were searched from inception to May 6th 2025. A randomised effects model was used to predict pooled mean differences in patient groups with 95% confidence intervals.
Results: 9555 articles were identified with 27 included studies, comprising a total of 2142 patients. There was significantly impaired respiratory function in patients with nasal obstruction compared to patients with normal nasal function. Pooled mean differences for FEV1 was -8.21% [-12.22, -4.21] and FEF25-75% -5.02%[-7.36, -2.67]. Similar values were seen for FVC -4.46%[-9.41, 0.50], FEV1/FVC -3.42%[-7.83, 0.98], tidal volume -0.62mL[-41.95, 40.72], and PEFR -36.58L/min[-115.95, 42.80]. There was significant improvement in pulmonary function in nasally obstructed patients after nasal airway surgery. Pooled mean differences for FEV1 were 10.88%[5.05, 16.70], FVC 10.79%[4.87, 16.71], FEV1/FVC 1.28%[0.19, 2.38] and PEFR 52.31L/min[27.19, 77.43]. Similar values were seen for FEF25-75% 0.41[-0.01, 0.83].
Conclusion: Patients with nasal obstruction have a lower FEV1. Post-nasal airway surgery, improvements in FEV1, FVC, FEV1/FVC, and PEFR can be demonstrated. The meta-analysis suggests that nasal breathing and its restoration is physiologically advantageous for respiratory function.
