Facial Plast Surg
DOI: 10.1055/a-2160-4998
Original Research

Quantifying the Subjective Experience of Nasal Obstruction: A Review

1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
,
Sam P. Most
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
› Author Affiliations

Abstract

Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.



Publication History

Accepted Manuscript online:
25 August 2023

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Hilberg O. Objective measurement of nasal airway dimensions using acoustic rhinometry: methodological and clinical aspects. Allergy 2002; 57 (Suppl. 70) 5-39
  • 2 Stewart M, Ferguson B, Fromer L. Epidemiology and burden of nasal congestion. Int J Gen Med 2010; 3: 37-45
  • 3 Moubayed SP, Most SP. Evaluation and management of the nasal airway. Clin Plast Surg 2022; 49 (01) 23-31
  • 4 Hilberg O, Pedersen OF. Acoustic rhinometry: recommendations for technical specifications and standard operating procedures. Rhinol Suppl 2000; 16: 3-17
  • 5 André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2009; 34 (06) 518-525
  • 6 Kjaergaard T, Cvancarova M, Steinsvåg SK. Does nasal obstruction mean that the nose is obstructed?. Laryngoscope 2008; 118 (08) 1476-1481
  • 7 Poetker DM, Rhee JS, Mocan BO, Michel MA. Computed tomography technique for evaluation of the nasal valve. Arch Facial Plast Surg 2004; 6 (04) 240-243
  • 8 Terheyden H, Maune S, Mertens J, Hilberg O. Acoustic rhinometry: validation by three-dimensionally reconstructed computer tomographic scans. J Appl Physiol 2000; 89 (03) 1013-1021
  • 9 Hilberg O, Jensen FT, Pedersen OF. Nasal airway geometry: comparison between acoustic reflections and magnetic resonance scanning. J Appl Physiol 1993; 75 (06) 2811-2819
  • 10 Corey JP, Gungor A, Nelson R, Fredberg J, Lai V. A comparison of the nasal cross-sectional areas and volumes obtained with acoustic rhinometry and magnetic resonance imaging. Otolaryngol Head Neck Surg 1997; 117 (04) 349-354
  • 11 Corey JP, Nalbone VP, Ng BA. Anatomic correlates of acoustic rhinometry as measured by rigid nasal endoscopy. Otolaryngol Head Neck Surg 1999; 121 (05) 572-576
  • 12 Min YG, Jang YJ. Measurements of cross-sectional area of the nasal cavity by acoustic rhinometry and CT scanning. Laryngoscope 1995; 105 (7, Pt 1): 757-759
  • 13 Mamikoglu B, Houser S, Akbar I, Ng B, Corey JP. Acoustic rhinometry and computed tomography scans for the diagnosis of nasal septal deviation, with clinical correlation. Otolaryngol Head Neck Surg 2000; 123 (1, Pt 1): 61-68
  • 14 Rhee JS, Weaver EM, Park SS. et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 2010; 143 (01) 48-59
  • 15 Naito K, Iwata S. Current advances in rhinomanometry. Eur Arch Otorhinolaryngol 1997; 254 (07) 309-312
  • 16 Jones AS, Lancer JM, Stevens JC, Beckingham E. Rhinomanometry: do the anterior and posterior methods give equivalent results?. Clin Otolaryngol Allied Sci 1987; 12 (02) 109-114
  • 17 Clement PA, Halewyck S, Gordts F, Michel O. Critical evaluation of different objective techniques of nasal airway assessment: a clinical review. Eur Arch Otorhinolaryngol 2014; 271 (10) 2617-2625
  • 18 Lam DJ, James KT, Weaver EM. Comparison of anatomic, physiological, and subjective measures of the nasal airway. Am J Rhinol 2006; 20 (05) 463-470
  • 19 Bermüller C, Kirsche H, Rettinger G, Riechelmann H. Diagnostic accuracy of peak nasal inspiratory flow and rhinomanometry in functional rhinosurgery. Laryngoscope 2008; 118 (04) 605-610
  • 20 Angelos PC, Been MJ, Toriumi DM. Contemporary review of rhinoplasty. Arch Facial Plast Surg 2012; 14 (04) 238-247
  • 21 Rhee JS, Pawar SS, Garcia GJ, Kimbell JS. Toward personalized nasal surgery using computational fluid dynamics. Arch Facial Plast Surg 2011; 13 (05) 305-310
  • 22 Pawar SS, Garcia GJ, Kimbell JS, Rhee JS. Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function. Facial Plast Surg 2010; 26 (04) 320-327
  • 23 Garcia GJ, Rhee JS, Senior BA, Kimbell JS. Septal deviation and nasal resistance: an investigation using virtual surgery and computational fluid dynamics. Am J Rhinol Allergy 2010; 24 (01) e46-e53
  • 24 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
  • 25 Cannon DE, Rhee JS. Evidence-based practice: functional rhinoplasty. Otolaryngol Clin North Am 2012; 45 (05) 1033-1043
  • 26 Andrews PJ, Choudhury N, Takhar A, Poirrier AL, Jacques T, Randhawa PS. The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?. Clin Otolaryngol 2015; 40 (06) 698-703
  • 27 Spielmann PM, White PS, Hussain SS. Surgical techniques for the treatment of nasal valve collapse: a systematic review. Laryngoscope 2009; 119 (07) 1281-1290
  • 28 Clarke JD, Hopkins ML, Eccles R. Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold. Clin Otolaryngol 2005; 30 (01) 35-38
  • 29 Sipilä J, Suonpää J, Silvoniemi P, Laippala P. Correlations between subjective sensation of nasal patency and rhinomanometry in both unilateral and total nasal assessment. ORL J Otorhinolaryngol Relat Spec 1995; 57 (05) 260-263
  • 30 Hirschberg A, Rezek O. Correlation between objective and subjective assessments of nasal patency. ORL J Otorhinolaryngol Relat Spec 1998; 60 (04) 206-211
  • 31 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
  • 32 Stewart MG, Smith TL, Weaver EM. et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004; 130 (03) 283-290
  • 33 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
  • 34 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
  • 35 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
  • 36 Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg 2013; 15 (05) 358-361
  • 37 Barone M, Cogliandro A, Di Stefano N, Tambone V, Persichetti P. A systematic review of patient-reported outcome measures after rhinoplasty. Eur Arch Otorhinolaryngol 2017; 274 (04) 1807-1811
  • 38 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-item standardized cosmesis and health nasal outcomes survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
  • 39 Saltychev M, Kandathil CK, Abdelwahab M, Spataro EA, Moubayed SP, Most SP. Psychometric properties of the standardized cosmesis and health nasal outcomes survey: item response theory analysis. JAMA Facial Plast Surg 2018; 20 (06) 519-521
  • 40 Saltychev M, Kandathil CK, Abdelwahab M, Spataro EA, Moubayed SP, Most SP. Confirmatory factor analysis of the standardized cosmesis and health nasal outcomes survey. Plast Reconstr Surg 2019; 143 (02) 454e-456e
  • 41 Kandathil CK, Saltychev M, Abdelwahab M, Spataro EA, Moubayed SP, Most SP. Minimal clinically important difference of the standardized cosmesis and health nasal outcomes survey. Aesthet Surg J 2019; 39 (08) 837-840
  • 42 Patel P, Wadhwa H, Okland T, Kandathil C, Most SP. Comparison of the distribution of standardized cosmesis and health nasal outcomes survey scores between symptomatic and asymptomatic patients. Facial Plast Surg Aesthet Med 2022; 24 (04) 305-309
  • 43 Kandathil CK, Saltychev M, Patel PN, Most SP. Natural history of the standardized cosmesis and health nasal outcomes survey after rhinoplasty. Laryngoscope 2021; 131 (01) E116-E123
  • 44 Patel PN, Kandathil CK, Abdelhamid AS, Buba CM, Most SP. Matched cohort comparison of dorsal preservation and conventional hump resection rhinoplasty. Aesthetic Plast Surg 2023; 47 (03) 1119-1129
  • 45 Toriumi DM, Kovacevic M, Kosins AM. Structural preservation rhinoplasty: a hybrid approach. Plast Reconstr Surg 2022; 149 (05) 1105-1120
  • 46 Patel PN, Most SP. Combining open structural and dorsal preservation rhinoplasty. Clin Plast Surg 2022; 49 (01) 97-109
  • 47 Alan MA, Kahraman ME, Yüksel F, Yücel A. Comparison of dorsal preservation and dorsal reduction rhinoplasty: analysis of nasal patency and aesthetic outcomes by rhinomanometry, NOSE and SCHNOS Scales. Aesthetic Plast Surg 2023; 47 (02) 728-734
  • 48 Klassen AF, Cano SJ, East CA. et al. Development and psychometric evaluation of the FACE-Q scales for patients undergoing rhinoplasty. JAMA Facial Plast Surg 2016; 18 (01) 27-35
  • 49 Manahan MAMD, Fedok F, Davidson C. et al. Evidence-based performance measures for rhinoplasty: a multidisciplinary performance measure set. Plast Reconstr Surg 2021; 147 (02) 222e-230e
  • 50 Rhee JS, Arganbright JM, McMullin BT, Hannley M. Evidence supporting functional rhinoplasty or nasal valve repair: a 25-year systematic review. Otolaryngol Head Neck Surg 2008; 139 (01) 10-20
  • 51 Most SP, Moubayed SP. Patient-reported outcome measures for facial plastic surgery: a specialty finally gets to go to the PROM. JAMA Facial Plast Surg 2017; 19 (02) 101