Development of a Severity Classification System for Subjective Nasal Obstruction

Abstract

asal airway obstruction (NAO) is a common presenting symptom in otolaryngology and facial plastic surgery practices. The potential for multiple contributing causes requires extensive evaluation. Many objective and subjective instruments are available to quantify the severity of the obstruction. One subjective quality-of-life instrument is the Nasal Obstruction Symptom Evaluation (NOSE) scale. 1 The NOSE scale is a brief, valid, reliable, and responsive survey to measure disturbances in quality of life specific to nasal obstruction. The results of objective measures of obstruction and subjective NOSE scores correlate poorly. 2 As a consequence, many recent studies 3-6 use the NOSE survey as a primary outcome measure for surgical treatment of nasal obstruction. IMPORTANCE Nasal airway obstruction is a common presenting symptom in otolaryngology and facial plastic surgery practices, and the potential for multiple contributing causes requires extensive evaluation. OBJECTIVE To develop a classification system for nasal obstruction using a subjective, validated quality-of-life instrument. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of patients' responses on the Nasal Obstruction Symptom Evaluation (NOSE) instrument performed from July 2011 through May 2012. All patients were seen at a university-based tertiary medical center. MAIN OUTCOMES AND MEASURES Scores from patients with or without nasal obstruction were used to develop a classification system after receiver operating characteristic curve analysis. The classification subdivides nasal obstruction scores into a range of defined classes. RESULTS Data analysis was performed using results from 345 patients. A score of 30 on the NOSE survey best differentiated patients with and without nasal obstruction. This threshold also provided intervals used to define the other class ranges. Patients were categorized as having mild (range, 5-25), moderate (range, 30-50), severe (range, 55-75), or extreme (range, 80-100) nasal obstruction, depending on responses on the NOSE survey. CONCLUSIONS AND RELEVANCE The NOSE scale is an important tool for gauging symptoms in patients with nasal obstruction. The proposed classification system will improve patient care by providing a framework for the severity of their symptoms and helping them understand potential treatment effects. If the classification is used in future outcomes research, it will allow physicians to better understand the study patient population and the effect of treatment on each severity class. LEVEL OF EVIDENCE NA

A prospective, non-randomized evaluation of a novel low energy radiofrequency treatment for nasal obstruction and snoring

“…The NOSE survey consists of five items assessing problems associated with or resulting from nasal obstruction [4]. A NOSE score of 30 is most appropriate to differentiate patients with and without nasal obstruction and is indicative of at least a moderate (instead of only mild) severity of nasal obstruction according to findings of Lipan and Most [5]. …”

Evidence-Based Medicine

“…This allowed the addition of a clinician-derived report of outcomes to provide context to the subjective patient-reported NOSE scores. 17 Discordance of objective and subjective outcome measures One of the most significant criticisms of objective measures of nasal patency and airflow as an indicator of treatment success is that there seems to be a poor correlation between these objective findings and patient-reported obstructive symptoms. Interestingly, nasal sensation of airflow seems to play a critical, though not yet fully understood, role in subjective nasal obstruction.…”

Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP‐treated obstructive sleep apnoea

“…The total score represents the sum of the responses to the five items and ranges from 0 to 100. 18 Higher scores indicate greater obstruction.…”