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
