Validation of a grading system for lateral nasal wall insufficiency

Abstract

This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.

Keywords: Collapse; grading; internal valve; lateral nasal wall; lateral wall; nasal valve; obstruction.

Conflict of interest statement

The authors have no conflicts of interest to declare pertaining to this article

Figures

Figure 1.

Zones of lateral nasal wall insufficiency. Zone 1 (upper zone) corresponds to dynamic internal nasal valve collapse. Zone 2 (lower zone) corresponds to classic external valve collapse.

Figure 2.

Grading system for lateral nasal wall collapse. (1) Identify the junction of the upper and lower cartilages (black arrow) just above the recurvature of the lower lateral cartilage. (2) Imagine a line parallel to the nasal floor across to the septum. (3) Estimate the degree of collapse during inspiration as a percentage compared with repose.