Poor mental health could lead to unnecessary nasal surgery

Surgeons who rely on a patient’s own report of their nasal function may not be getting an accurate picture – unless they first assess their patient’s mental health, UNSW research finds.

Patients electing for rhinoplasty may overestimate the seriousness of their condition due to underlying poor mental health or self-esteem, a UNSW study finds.

A total of 495 patients with breathing difficulties took part in the study published in JAMA Facial Plastic Surgery, including patients who were undergoing evaluation for nasal surgery, considering surgery or who had previously undergone surgery.

The study shows that patients with poor mental health perceived their nasal airflow as significantly poorer than patients with good mental health, despite no objective difference in nasal function between both groups.

The findings underline that surgeons may not always be able to rely on a patient’s own report of their nasal function.

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.

UNSW Medicine sixth-year student Erika Strazdins, the paper’s first author, says it is an important study for rhinoplasty surgeons, who rely on patient self-reports and their “instinct” and “experience” to assess whether surgery is necessary for nasal function and cosmetic appearance.

“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,” Ms Strazdins says.

“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.”

Nasal function was perceived as “severe or worse” in 40% of those with poor mental well-being compared to 23% of those with normal mental well-being.

Even more significant differences were seen with self-esteem, with 100% of patients with low self-esteem perceiving nasal functions “severe or worse” compared to 59% with normal self-esteem.

Asking patients to fill out a mental health survey during per-surgery consultations could help surgeons determine the need for surgery, the authors say.

For those patients who score poorly on mental health, surgeons could opt for further consultations, refer the patient for an objective nasal airflow assessment, or even suggest psychotherapy to further clarify the need for surgery.

This additional referral will also give patients a better understanding of their true nasal function and what surgery might achieve.

In the study, patients at two Sydney rhinoplasty centres in Sydney were asked to fill out the Short Form Health Survey, the Rosenberg Self-Esteem Scale and the Dysmorphic Concerns Questionnaire to determine their mental health status.

They then underwent nasal airflow assessment. The results for those with poor mental health were compared with those with good mental health.

Given cultural norms on appearance, rhinoplasty and mental health differ across countries, the results are limited to Australia. The study also acknowledges that further investigation employing larger samples would lend more confidence to these findings.

(Source: UNSW, JAMA Facial Plastic Surgery)