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

  • D Chin (a1) (a2), J Malek (a3), E Pratt (a3), G Marcells (a4) (a5), R Sacks (a3) (a6) (a7) (a8) and R J Harvey (a3) (a6) (a9)...

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.

Copyright

Corresponding author

Address for correspondence: Dr David Chin, 354 Victoria Street, Darlinghurst, NSW, Australia2010 Fax: +61 (0)2 9360 9919 E-mail: drdavidchin@gmail.com

Footnotes

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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.

Footnotes

References

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1Hirschberg, A, Rezek, O. Correlation between objective and subjective assessments of nasal patency. ORL J Otorhinolaryngol Relat Spec 1998;60:206–11
2Sipila, J, Suonpaa, J, Laippala, P. Sensation of nasal obstruction compared to rhinomanometric results in patients referred for septoplasty. Rhinology 1994;32:141–4
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;20:20–4
4Silkoff, PE, Chakravorty, S, Chapnik, J, Cole, P, Zamel, N. Reproducibility of acoustic rhinometry and rhinomanometry in normal subjects. Am J Rhinol 1999;13:131–5
5Thulesius, HL, Cervin, A, Jessen, M. Can we always trust rhinomanometry? Rhinology 2011;49:4652
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;41:582–92
7Sloan, JA. Assessing the minimally clinically significant difference: scientific considerations, challenges and solutions. COPD 2005;2:5762
8Hays, RD, Woolley, JM. The concept of clinically meaningful difference in health-related quality-of-life research. How meaningful is it? Pharmacoeconomics 2000;18:419–23
9Clement, PA, Gordts, F. Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 2005;43:169–79
10Williams, RG, Eccles, R. Nasal airflow asymmetry and the effects of a topical nasal decongestant. Rhinology 1992;30:277–82
11Moore, M, Eccles, R. Normal nasal patency: problems in obtaining standard reference values for the surgeon. J Laryngol Otol 2012;126:563–9
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;34:518–25
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;52:861–73
14Tompos, T, Garai, T, Zemplen, B, Gerlinger, I. Sensation of nasal patency compared to rhinomanometric results after septoplasty. Eur Arch Otorhinolaryngol 2010;267:1887–91
15Sanz, L, Guerrero, JA, Rivera, T. Correlation between active anterior rhinomanometry and nasal endoscopy [in Spanish]. Acta Otorrinolaringol Esp 2010;61:215–19
16McKee, GJ, O'Neill, G, Roberts, C, Lesser, TH. Nasal airflow after septorhinoplasty. Clin Otolaryngol Allied Sci 1994;19:254–7
17Thomson, C, Mendelsohn, M. Reducing the incidence of revision rhinoplasty. J Otolaryngol 2007;36:130–4
18Naclerio, RM, Bachert, C, Baraniuk, JN. Pathophysiology of nasal congestion. Int J Gen Med 2010;3:4757
19Arbour, P, Kern, EB. Paradoxical nasal obstruction. Can J Otolaryngol 1975;4:333–8
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;37:1722
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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