Unilateral Nasal Obstruction Causes Symptom Severity Scores Similar to Bilateral Nasal Obstruction

Abstract

The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p < 0.001). On multiple linear regression, total, left, and right septal deviation (p < 0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p < 0.001, p = 0.003, p < 0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.

Keywords

nasal obstruction - septorhinoplasty - NOSE scale - nasal anatomic worksheet

Publication History

Article published online:
27 July 2020

• References

• 1 Chandra RK, Kern RC, Cutler JL, Welch KC, Russell PT. REMODEL larger cohort with long-term outcomes and meta-analysis of standalone balloon dilation studies. Laryngoscope 2016; 126 (01) 44-50
• 2 Rhee JS, Poetker DM, Smith TL, Bustillo A, Burzynski M, Davis RE. Nasal valve surgery improves disease-specific quality of life. Laryngoscope 2005; 115 (03) 437-440
• 3 Gadkaree SK, Fuller JC, Justicz NS. , et al. A comparative health utility value analysis of outcomes for patients following septorhinoplasty with previous nasal surgery. JAMA Facial Plast Surg 2019; 21 (05) 402-406
• 4 Gadkaree SK, Fuller JC, Justicz NS. , et al. Health utility values as an outcome measure in patients undergoing functional septorhinoplasty. JAMA Facial Plast Surg 2019; 21 (05) 381-386
• 5 Gliklich RE, Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg 1995; 113 (01) 104-109
• 6 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
• 7 Lindsay RW. Disease-specific quality of life outcomes in functional rhinoplasty. Laryngoscope 2012; 122 (07) 1480-1488
• 8 Justicz N, Gadkaree SK, Fuller JC, Locascio JJ, Lindsay RW. Preoperative characteristics of over 1,300 functional septorhinoplasty patients. Laryngoscope 2020; 130 (01) 25-31
• 9 Colaianni CA, Levesque PA, Lindsay RW. Integrating data collection into office work flow and electronic health records for clinical outcomes research. JAMA Facial Plast Surg 2017; 19 (06) 528-532
• 10 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 11 Rhee JS, Sullivan CD, Frank DO, Kimbell JS, Garcia GJ. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plast Surg 2014; 16 (03) 219-225 , quiz 232
• 12 Most SP. Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2006; 8 (05) 306-309
• 13 Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg 2013; 15 (05) 358-361
• 14 Miljeteig H, Hoffstein V, Cole P. The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea. Laryngoscope 1992; 102 (10) 1150-1152
• 15 Hsu JC, Watari I, Funaki Y, Kokai S, Ono T. Unilateral nasal obstruction induces degeneration of fungiform and circumvallate papillae in rats. J Formos Med Assoc 2018; 117 (03) 220-226
• 16 Ishii LE, Tollefson TT, Basura GJ. , et al. Clinical practice guideline: improving nasal form and function after rhinoplasty executive summary. Otolaryngol Head Neck Surg 2017; 156 (02) 205-219
• 17 Camacho M, Zaghi S, Certal V. , et al. Inferior turbinate classification system, grades 1 to 4: development and validation study. Laryngoscope 2015; 125 (02) 296-302
• 18 Leitzen KP, Brietzke SE, Lindsay RW. Correlation between nasal anatomy and objective obstructive sleep apnea severity. Otolaryngol Head Neck Surg 2014; 150 (02) 325-331
• 19 Lindsay RW, George R, Herberg ME, Jackson P, Brietzke S. Reliability of a standardized nasal anatomic worksheet and correlation with subjective nasal airway obstruction. JAMA Facial Plast Surg 2016; 18 (06) 449-454
• 20 Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence) 2013; 4 (02) e66-e68
• 21 Bailey RS, Casey KP, Pawar SS, Garcia GJ. Correlation of nasal mucosal temperature with subjective nasal patency in healthy individuals. JAMA Facial Plast Surg 2017; 19 (01) 46-52