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Clinical commissioning group criteria for rhinoplasty and septorhinoplasty in England: survey of current guidance

  • E E Ross (a1) and S Anari (a2)
Abstract
Objective

Procedures of limited clinical value require pre-authorisation in the National Health Service, of which rhinoplasty and septorhinoplasty are two such operations. This study surveyed clinical commissioning groups within England to document the variable eligibility criteria for rhinoplasty and septorhinoplasty.

Methods

In February 2016, a letter was sent to 209 clinical commissioning groups requesting their rhinoplasty and septorhinoplasty commissioning criteria.

Results

A total of 200 clinical commissioning groups responded. Although 89.5 per cent allow septorhinoplasty in the presence of nasal obstruction, further criteria, such as documented health problems resulting from nasal blockage, severe functional impairment or a specific percentage of blockage, must be shown for septorhinoplasty to be authorised by most of the clinical commissioning groups.

Conclusion

There is great variation within individual clinical commissioning groups in England regarding the criteria for septorhinoplasty and rhinoplasty. Some criteria seem not to be clinically relevant and difficult to demonstrate. It is recommended that the guidelines are reviewed and harmonised nationally in future revisions.

Copyright
Corresponding author
Address for correspondence: Miss Elizabeth E Ross, Department of ENT, Health Education West Midlands, St Chads Court, 213 Hagley Road, Birmingham B16 9RG, UK E-mail: elizabethross1@nhs.net
Footnotes
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Miss E E Ross takes responsibility for the integrity of the content of the paper

Footnotes
References
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1NHS Clinical Commissioners. About CCGs. In: https://www.nhscc.org/ccgs/ [29 April 2017]
3Ishii, L, Roxbury, C, Godoy, A, Ishman, S, Ishii, M. Does nasal surgery improve OSA in patients with nasal obstruction and OSA? A meta-analysis. Otolaryngol Head Neck Surg 2015;153:326–33
4Wu, J, Zhao, G, Li, Y, Zang, H, Wang, T, Wang, D et al. Apnea-hypopnea index decreased significantly after nasal surgery for obstructive sleep apnea: a meta-analysis. Medicine (Baltimore) 2017;96:e6008
5National Institute of Health and Care Excellence. Clinical Knowledge Summary: Obstructive Sleep Apnoea. In: https://cks.nice.org.uk/obstructive-sleep-apnoea-syndrome#!backgroundsub:3 [29 April 2017]
6Stewart, M, Witsell, D, Smith, T, Weaver, E, Yueh, B, Hannley, M. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004;130:157–63
7Stewart, MG, Smith, TL, Weaver, EM, Witsell, DL, Yueh, B, Hannley, MT et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004;130:283–90
8Floyd, E, Ho, S, Patel, P, Rosenfeld, R, Gordin, E. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngol Head Neck Surg 2017;156:809–15
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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