Correlation between Objective and Subjective Assessment of Nasal Patency

Document Type : Original


1 Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy.

2 Division of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, University of Milan, Milan, Italy.

3 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.


This study was performed to evaluate the correlation between the objective and subjective sensation of nasal patency, assessed through a validated questionnaire, the Italian version of the NOSE scale, and the rhinomanometric results in a large cohort of patients complaining about nasal obstruction.  
Materials and Methods:
Data was obtained from a total of 233 adult patients, (123 males, 110 females, with a mean age of 43.7 years) with a diagnosis of septal deviation and complaining about nasal obstruction. Anterior active rhinomanometry was used for objective assessment, while the I-NOSE scale and a visual analog scale (VAS) were used for subjective evaluation.
Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found.The higher correlation was demonstrated between the HUNR (higher unilateral nasal resistance) parameter of rhinomanometry and the second item of the I-NOSE scale (Nasal blockage or obstruction). No significant correlation was found between the fourth item of the I-NOSE (Trouble sleeping) and the VAS score. The VAS score appeared mildly, but still significantly, correlated with the HUNR parameter of rhinomanometry.
The correlation between the subjective sensation of nasal patency and the rhinomanometric data proved to be significant. No correlation between subjective sensation of trouble sleeping and rhinomanometric assessment was found. In counselling with patients complaining of nasal obstruction trouble in sleeping should not be considered as a symptom related to nasal obstruction.


Main Subjects

1. Rhee JS, Book DT, Burzynski M, Smith TL. Quality of life assessment in nasal airway obstruction. Laryngoscope 2003; 113(7):1118-22.
2. Andrè RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ. Correlation between subjective and objective evaluation of the nasal airways. A systematic review of the highest level of evidence. Clin Otolaryngol 2009; 34(6):518-25.
3. 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(2):157-63.
4. Katz S, Schmelzer B, Vidts G. Treatment of the obstructive nose by CO2-laser reduction of the inferior turbinates: technique and results. Am J Rhinol 2000; 14(1):51-5.
5. Pirila T, Tikanto J. Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry and subjective assessment. Am J Rhinol 2001; 15(2):127-33.
6. Menger DJ, Swart KM, Nolst Trenité GJ, Georgalas C, Grolman W. Surgery of the external nasal valve: the correlation between subjective and objective measurements. Clin Otolaryngol 2014; 39(3):150-5.
7. Jones AS, Willatt DJ, Durham LM. Nasal airflow: resistance and sensation. J Laryngol Otol 1989; 103(10):909-11.
8. Kim CS, Moon BK, Jung DH, Min YG. Correlation between nasal obstruction symptoms and objective parameters of acoustic rhinometry and rhinomanometry. Auris Nasus Larynx 1998; 25(1):45-8.
9. Sipila J, Suonpaa J, Silvoniemi P, Laippala P. Correlations between subjective sensation of nasal patency and rhinomanometry in both unilateral and total assessment. ORL 1995; 57(5):260-3.
10. Numminen J, Ahtinen M, Huhtala H, Rautiainen M. Comparison of rhinometric measuments methods in intranasal pathology. Rhinology 2003; 41(2):65-8.
11. Ng TY, Chen YF, Tsai MH, Huang KH, Tai CJ. Objective measurements differ for perception of left and right nasal obstruction. Auris Nasus Larynx 2013; 40(1):81-4.
12. Tompos T, Garai T, Zemplen B, Gerlinger I. Sensation of nasal patency compared to rhinomanometric results after septoplasty. Eur Arch Otorhinolaryngol 2010; 267(12):1887-91.
13. Van Oenne CM, Van Reji EJ, Sprangers MA, Fokkens WJ. Quality-assessment of disease-specific quality of life questionnaires for rhinitis and rhinosinusistis. A systematic review. Allergy 2007; 62(12):1359-71.
14. Bezerra TF, Padua FG, Pilan RR, Stewart MG, Voegels RL. Cross-cultural adaptation and validation of a quality of life questionnaire: the Nose Ostruction Symptom Evaluation questionnaire. Rhinology 2011; 49(2):227-31.
15. Marro M, Mondina M, Stoll D, De Gabory L. French validation of the NOSE and RhinoQOL questionnaires in the management of nasal obstruction. Otolaryngology Head Neck Surg 2011; 144(6):988-93.
16. Mozzanica F, Urbani E, Atac M, Scottà G, Luciano K, Bulgheroni C, et al. Reliability and validity of the Italian nose obstruction symptom evaluation (I-NOSE) scale. Eur Arch of Otolarhinolaryngol 2013; 270(12): 3087-94.
17. Mondina M, Marro M, Maurice S, Stoll D, De Gabory L. Assessment of nasal septoplasty using NOSE and RhinoQOL questionnaires. Eur Arch Otorhinolaryngol 2012; 269(10):2189-95.
18. Kahveci OK, Miman MC, Yucel A, Yucedag G, Okur E, Altuntas A. The efficiency of Nose Ostruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation. Auris Nasus Larynx 2012; 39(3):275-9.
19. Most SM. Analysis of outcomes after functional rhinoplasty using a disease specific quality of life instrument. Arch Facial Plast Surg 2006; 8(5):306-9.
20. Hsu HC, Tan CD, Chang CW, Chu CW, Chiu YC, Pan CJ, et al. Evaluation of nasal patency by VAS/NOSE questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study. Clin Otolaryngol. 2016; doi: 10.1111/coa.12662 [Epub ahead of print].
21. Braun T, Rich M, Kramer MF. Correlation of three variables describing nasal patency (HD, MCA, NOSE score) in healthy subjects. Braz J Otorhinolaryngol 2013; 79(3):354-8.
22. Simola M, Malmberg H. Sensation of nasal airflow 
compared with nasal airway resistance in patients with rhinitis. Clin Otolaryngol 1997;22 (3): 260–2.
23. Szucks E, Clement PA. Acoustic rhinometry and rhinomanometry in the evaluation of nasal patency of patients with 
nasal septal deviation. Am J Rhinol 1998; 12(5):345–52.
24. Clement PAR. Committee report on standardization of rhinomanometry. Rhinology 1984; 22(3):151-5.