Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales.

Macario Camacho,Rahul Modi,Edward T Chang,Anthony M Tolisano,Jose Abdullatif,Robson Capasso,Shankar Sridhara,Soroush Zaghi,Victor Certal,Benjamin B Cable

doi:10.1155/2016/6945297

Abstract

Objective. To evaluate the association between nasal obstruction and (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Study Design. Case series. Methods. Chart review at a tertiary medical center. Results. Two hundred-forty consecutive patients (52.1 ± 17.5 years old, with a Nasal Obstruction Symptom Evaluation (NOSE) score of 32.0 ± 24.1) were included. Demographic factors and inferior turbinate sizes were not associated with NOSE score or Nasal Obstruction Visual Analog Scale (NO-VAS). A significant association was found between higher NOSE score on univariate analysis and positive history of nasal trauma (p = 0.0136), allergic rhinitis (p < 0.0001), use of nasal steroids (p = 0.0108), higher grade of external nasal deformity (p = 0.0149), higher internal nasal septal deviation grade (p = 0.0024), and narrow internal nasal valve angle (p < 0.0001). Multivariate analysis identified the following as independent predictors of high NOSE score: NO-VAS: ≥50 (Odds Ratio (OR) = 17.6 (95% CI 5.83–61.6), p < 0.0001), external nasal deformity: grades 2–4 (OR = 4.63 (95% CI 1.14–19.9), p = 0.0339), and allergic rhinitis: yes (OR = 5.5 (95% CI 1.77–18.7), p = 0.0041). Conclusion. Allergic rhinitis, NO-VAS score ≥ 50, and external nasal deformity (grades 2–4) were statistically significant independent predictors of high NOSE scores on multivariate analysis. Inferior turbinate size was not associated with NOSE scores or NO-VAS.

Highlights

Nasal obstruction is a frequent complaint, which affects breathing during wakefulness and sleep [1]
Inferior turbinate size was not associated with Nasal Obstruction Symptom Evaluation (NOSE) scores or Nasal Obstruction Visual Analog Scale (NO-VAS)
The following nasal physical exam findings were associated with higher NOSE scores on univariate analysis: higher grade of external nasal deformity (Odds Ratio (OR) = 3.59, p = 0.0002), higher grade of internal nasal septal deviation (OR = 2.05, p = 0.0168), and narrow internal nasal valve angle (OR = 4.34, p < 0.0001)

Summary

Introduction

Nasal obstruction is a frequent complaint, which affects breathing during wakefulness and sleep [1]. Systematic evaluation of nasal obstruction remains challenging due to the high number of variables and factors that can contribute to nasal obstruction These can be grouped into four major categories: (1) demographic factors, (2) medical history, (3) physical tests, and (4) nasal exam findings. Some patients with internal nasal septal deviations, narrow internal nasal valve angles, and/or large inferior turbinates may have no or few complaints of nasal obstruction, while other patients may complain of nasal obstruction despite the presence of minimal objective anatomical abnormalities These observations are well known to otolaryngologists, but the efforts to quantify obstruction in a way that allows for systematic study have been a long term challenge. Several grading scales and classification systems (for nasal physical exam findings) and questionnaires (for nasal obstruction) have been developed over the years to assist in the quantification and assessment of nasal obstruction

Methods

Results

Conclusion