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Patient self-assessment in discriminating the more obstructed side in nasal breathing

Published online by Cambridge University Press:  07 August 2013

D Chin ,
J Malek ,
E Pratt ,
G Marcells ,
R Sacks  and
R J Harvey
D Chin*
Affiliation:
Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia Department of Otolaryngology, Head & Neck Surgery, Changi General Hospital, Singapore
J Malek
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia
E Pratt
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia
G Marcells
Affiliation:
Bondi Junction Private Hospital, Sydney, Australia Department of Otolaryngology, Sydney Hospital, Sydney, Australia
R Sacks
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, Sydney, Australia Department of Otolaryngology, Macquarie University Hospital, Sydney, Australia
R J Harvey
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
*
Address for correspondence: Dr David Chin, 354 Victoria Street, Darlinghurst, NSW, Australia2010 Fax: +61 (0)2 9360 9919 E-mail: [email protected]
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Abstract

Background:

Correlating patient perception of nasal obstruction sidedness to causative anatomy is important in surgical planning. The accuracy of patient-perceived asymmetry of nasal obstruction, as regards objective measures, is described.

Methods:

Cross-sectional study of patients undergoing nasal airflow assessment. Unilateral obstruction was assessed using visual analogue scale scores and anterior rhinomanometry, without decongestion. Subjective obstruction asymmetry was defined using either the absolute score difference (right vs left) or the minimal clinically important difference, derived statistically. Correlation between subjective and objective obstruction measures was assessed.

Results:

In 145 patients (mean age ± standard deviation, 42.8 ± 16.6 years; 54.5 per cent female), objective obstruction was right-sided in 32.4 per cent, left-sided in 36.6 per cent and symmetrical in 31.0 per cent. Subjective perception of obstruction sidedness had a sensitivity and specificity of 86.9 and 41.1 per cent, respectively, using the minimal clinically important difference. Positive predictive value was 59.4 per cent using absolute score difference and 53.7 per cent using minimal clinically important difference. Receiver operator characteristic curve analysis indicated correlation between subjective and objective measures (p < 0.001).

Conclusion:

Subjective perception of nasal obstruction asymmetry has limited accuracy. Corroboration with objective airway assessment may be helpful in patients whose symptoms are incongruous with clinical findings.

Keywords

Nasal ObstructionNasal SeptumRhinomanometryNasal Surgical ProceduresTurbinates
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Supplement S1 , January 2014 , pp. S34 - S39
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

Presented as a poster at the 2012 Annual Scientific Meeting, Australian Society of Otolaryngology Head and Neck Surgery, 30 March to 3 April 2012, Adelaide, South Australia, Australia, and the 15th Asian Research Symposium in Rhinology (2012), 25–26 May 2012, Singapore.

References

1Hirschberg, A, Rezek, O. Correlation between objective and subjective assessments of nasal patency. ORL J Otorhinolaryngol Relat Spec 1998;60:206–11CrossRefGoogle ScholarPubMed
2Sipila, J, Suonpaa, J, Laippala, P. Sensation of nasal obstruction compared to rhinomanometric results in patients referred for septoplasty. Rhinology 1994;32:141–4Google ScholarPubMed
3Clarke, JD, Hopkins, ML, Eccles, R. How good are patients at determining which side of the nose is more obstructed? A study on the limits of discrimination of the subjective assessment of unilateral nasal obstruction. Am J Rhinol 2006;20:20–4CrossRefGoogle Scholar
4Silkoff, PE, Chakravorty, S, Chapnik, J, Cole, P, Zamel, N. Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects. Am J Rhinol 1999;13:131–5CrossRefGoogle ScholarPubMed
5Thulesius, HL, Cervin, A, Jessen, M. Can we always trust rhinomanometry? Rhinology 2011;49:46–52CrossRefGoogle ScholarPubMed
6Norman, GR, Sloan, JA, Wyrwich, KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003;41:582–92CrossRefGoogle ScholarPubMed
7Sloan, JA. Assessing the minimally clinically significant difference: scientific considerations, challenges and solutions. COPD 2005;2:57–62CrossRefGoogle ScholarPubMed
8Hays, RD, Woolley, JM. The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Pharmacoeconomics 2000;18:419–23CrossRefGoogle Scholar
9Clement, PA, Gordts, F. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005;43:169–79Google ScholarPubMed
10Williams, RG, Eccles, R. Nasal airflow asymmetry and the effects of a topical nasal decongestant. Rhinology 1992;30:277–82Google ScholarPubMed
11Moore, M, Eccles, R. Normal nasal patency: problems in obtaining standard reference values for the surgeon. J Laryngol Otol 2012;126:563–9CrossRefGoogle ScholarPubMed
12Andre, RF, Vuyk, HD, Ahmed, A, Graamans, K, Nolst Trenite, GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009;34:518–25CrossRefGoogle ScholarPubMed
13Wyrwich, KW, Tierney, WM, Wolinsky, FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. J Clin Epidemiol 1999;52:861–73CrossRefGoogle ScholarPubMed
14Tompos, T, Garai, T, Zemplen, B, Gerlinger, I. Sensation of nasal patency compared to rhinomanometric results after septoplasty. Eur Arch Otorhinolaryngol 2010;267:1887–91CrossRefGoogle ScholarPubMed
15Sanz, L, Guerrero, JA, Rivera, T. Correlation between active anterior rhinomanometry and nasal endoscopy [in Spanish]. Acta Otorrinolaringol Esp 2010;61:215–19CrossRefGoogle ScholarPubMed
16McKee, GJ, O'Neill, G, Roberts, C, Lesser, TH. Nasal airflow after septorhinoplasty. Clin Otolaryngol Allied Sci 1994;19:254–7CrossRefGoogle ScholarPubMed
17Thomson, C, Mendelsohn, M. Reducing the incidence of revision rhinoplasty. J Otolaryngol 2007;36:130–4CrossRefGoogle ScholarPubMed
18Naclerio, RM, Bachert, C, Baraniuk, JN. Pathophysiology of nasal congestion. Int J Gen Med 2010;3:47–57CrossRefGoogle ScholarPubMed
19Arbour, P, Kern, EB. Paradoxical nasal obstruction. Can J Otolaryngol 1975;4:333–8Google ScholarPubMed
20Thulesius, HL, Cervin, A, Jessen, M. The importance of side difference in nasal obstruction and rhinomanometry: a retrospective correlation of symptoms and rhinomanometry in 1000 patients. Clin Otolaryngol 2012;37:17–22CrossRefGoogle ScholarPubMed