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

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

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.

Figures

Figure 1
Figure 1
Inferior turbinate sizes. (a) Grade 1 (0%–25% of total airway space). (b) Grade 2 (26%–50% of total airway space). (c) Grade 3 (51%–75% of total airway space). (d) Grade 4 (76%–100% of total airway space). Reproduced with permission [2].

References

    1. Hsia J. C., Camacho M., Capasso R. Snoring exclusively during nasal breathing: a newly described respiratory pattern during sleep. Sleep & Breathing. 2014;18(1):159–164. doi: 10.1007/s11325-013-0864-x.
    1. Camacho M., Zaghi S., Certal V., et al. Inferior turbinate classification system, grades 1 to 4: development and validation study. The Laryngoscope. 2015;125:296–302.
    1. Stewart M. G., Witsell D. L., Smith T. L., Weaver E. M., Yueh B., Hannley M. T. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Otolaryngology—Head and Neck Surgery. 2004;130(2):157–163. doi: 10.1016/j.otohns.2003.09.016.
    1. Ciprandi G., Mora F., Cassano M., Gallina A. M., Mora R. Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis. Otolaryngology-Head and Neck Surgery. 2009;141(4):527–529. doi: 10.1016/j.otohns.2009.06.083.
    1. Tsao G. J., Fijalkowski N., Most S. P. Validation of a grading system for lateral nasal wall insufficiency. Allergy & Rhinology. 2013;4(2):e66–e68. doi: 10.2500/ar.2013.4.0054.
    1. Heinberg C. E., Kern E. B. The Cottle sign: an aid in the physical diagnose of nasal airflow disturbances. Rhinology. 1973;11(3):89–94.
    1. Rohrich R. J., Gunter J. P., Deuber M. A., Adams W. P., Jr. The deviated nose: optimizing results using a simplified classification and algorithmic approach. Plastic and Reconstructive Surgery. 2002;110(6):1509–1524. doi: 10.1097/00006534-200211000-00018.
    1. Rhee J. S., Sullivan C. D., Frank D. O., Kimbell J. S., Garcia G. J. M. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plastic Surgery. 2014;16(3):219–225. doi: 10.1001/jamafacial.2013.2473.
    1. Camacho M., Riaz M., Capasso R., et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. SLEEP. 2015;38(2):279–286. doi: 10.5665/sleep.4414.
    1. Friedman M., Tanyeri H., La Rosa M., et al. Clinical predictors of obstructive sleep apnea. The Laryngoscope. 1999;109(12):1901–1907. doi: 10.1097/00005537-199912000-00002.

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