Background: Acoustic rhinometry has traditionally been considered a research modality due to concerns about reproducibility and its variable correlation with patient-reported outcomes. Advances in technology now allow reliable, user-independent measurements. This study reports our department’s novel experience with integrating routine intraoperative acoustic rhinometry to provide objective assessment of nasal anatomy and its relationship to symptom improvement following functional nasal surgery.

Methods: We performed a retrospective analysis of 50 consecutive patients undergoing functional nasal surgery, including revisions. Acoustic rhinometry measurements were recorded preoperatively, intraoperatively, and at 8–12 week follow-up. Patient-reported outcomes were assessed using NOSE and VAS scores. The Russell Number (R) represented the minimal cross-sectional area of the anterior nasal cavity, and an asymmetry index quantified side-to-side differences. Statistical significance was defined as p<0.05. 

Results: Intraoperative increases in R were maintained at follow-up and correlated with VAS improvement (r=0.392, p=0.039). Patients accurately identifying the obstructed side had higher baseline asymmetry (22% vs. 7%, p=0.003), which improved significantly intraoperatively and at follow-up. Both NOSE and VAS scores showed marked improvement postoperatively (p<0.0001). Acoustic rhinometry demonstrated excellent reproducibility with near-perfect inter-operator (ICC 0.964) and intra-operator (ICC 0.979) agreement. 

Conclusions: Routine intraoperative acoustic rhinometry offers immediate, objective insight into nasal anatomy and surgical effects, detecting changes that persist over time and align with patient-reported improvement. It is sensitive to surgical technique and symmetry restoration. Incorporating acoustic rhinometry as a standard intraoperative tool may enhance consistency in surgical outcomes and optimize patient satisfaction in functional nasal surgery.

Jemima Russell is a fifth-year medical student at Imperial College London with a BSc in Surgical Design, Technology, and Innovation. She has coauthored three peer-reviewed publications and is currently conducting clinical research at Charing Cross Hospital, a leading tertiary care centre in London. She is supervised by leading consultants and world-renowned rhinologists, including Professor Hesham Saleh.