Objective measurement and patient‐reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow?

Abstract

Background Evidence has shown that the sensation of nasal breathing is related to variations in nasal mucosa temperature produced by airflow. An appropriate nasal airflow is necessary for changing mucosal temperature. Therefore, the correlation between objective measurements of nasal airflow and patient‐reported evaluation of nasal breathing should be dependent on the level of nasal airflow. Objectives To find if the correlation between patient‐reported assessment of nasal breathing and objective measurement of nasal airflow is dependent on the severity of symptoms of nasal obstruction or on the level of nasal airflow. Methods The airway of 79 patients was evaluated using NOSE score and peak nasal inspiratory flow (PNIF). Three subgroups were created based on NOSE and three subgroups were created based on PNIF level to find if correlation was dependent on nasal symptoms or airflow. Results The mean value of PNIF for the 79 patients was 92.6 L/min (SD 28.1 L/min). The mean NOSE score was 48.4 (SD 24.4). The correlation between PNIF and NOSE was statistically significant (P = .03), but with a weak association between the two variables (r = −.248). Evaluation of correlation based on symptoms demonstrated a weak or very weak association in each subgroup (r = −.250, r = −.007, r = −.104). Evaluation of correlation based on nasal airflow demonstrated a very weak association for the subgroups with middle‐level and high PNIF values (r = −.190, r = −.014), but a moderate association for the subgroup with low PNIF values (r = −.404). Conclusions This study demonstrated a weak correlation between NOSE scores and PNIF values in patients non‐selected according to symptoms of nasal obstruction or to airflow. It demonstrated that patients with symptoms of nasal obstruction have different levels of nasal airflow and that low nasal airflow prevents the sensation of good nasal breathing. Therefore, patients with symptoms of nasal obstruction may require improving nasal airflow to improve nasal breathing sensation.

Comparative Functional Effect of Alternative Surgical Techniques Used in Rhinoplasty

“…Interestingly, there was no significant difference in the pre-operative PNIF value between these 2 groups (Table 2). This finding confirms the lack of relevant correlation between nasal airflow and patient-reported assessment of nasal breathing demonstrated by several studies [21][22][23][24][25][26][27][28][29] and is probably related to the multifactorial nature of nasal breathing sensation, which is related to but not solely dependent on nasal airflow. It has been demonstrated that low airflow prevents the sensation of suitable nasal breathing, 27 but patients with and without sensation of suitable nasal breathing may have similar levels of airflow.…”

Overview of Nasal Airway and Nasal Breathing Evaluation

“…[36][37][38] Other studies have found correlation between nasal resistance and patient-reported measurements only in patients with nasal obstruction, [39][40][41][42][43][44] whereas other studies could not find correlation not even in symptomatic patients. [45][46][47][48] This lack of consistent correlation between objective measurements and patient-reported evaluation of nasal breathing suggests that factors other than the nasal airflow or nasal airway resistance are important for determining the subjective sensation of nasal breathing. There is evidence that the sensation of nasal breathing is mostly related to temperature variations caused by the cooling effect of the airstream on the mucosa of the nasal airway.…”

“…This explains the lack of correlation many times demonstrated between measurements of these variables and subjective appreciation of nasal breathing. 48,[60][61][62][63][64] Nevertheless, an appropriate nasal airflow is required to produce changes in the nasal mucosal temperature and to provoke shear stress in the walls of the nasal cavity, as to trigger stimulation of both the thermoreceptors and the mechanoreceptors. Bailey et al found a negative correlation between nasal resistance and the degree of mucosal cooling.…”

“…It was found that, despite a week correlation between nasal breathing sensation and nasal airflow regardless of the severity of symptoms, there was correlation between nasal breathing sensation and nasal airflow in patients with low airflow level. 48 This suggests that patients with symptoms of nasal obstruction may have different levels of nasal airflow, but low airflow levels prevent a suitable nasal breathing sensation.…”

Evidence-Based Medicine: Rhinoplasty Surgical Outcomes

“…41 However, another study by Xavier et al from 2021 examined the relationship between NOSE scores and PNIF values and demonstrated only a weak correlation between scores, further emphasizing the difficulty correlating objective findings to subjective results. 42 A limitation of this technique, similar to some of the previously mentioned instruments, is the variability in results based on mucosal congestion and the physiologic nasal cycle, and can fail to detect up to 25% of symptomatic patients with functionally relevant nasal structural deformities. 43 Still, a more recent prospective study by Fuller et al examining 136 patients, acknowledged the limitation between PNIF and subjective measures as a diagnostic tool, but did suggest utility on an individual scale to determine objective improvements following surgery.…”