Original Investigation |

Development of a Severity Classification System for Subjective Nasal Obstruction

Michael J. Lipan, MD1; Sam P. Most, MD1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
JAMA Facial Plast Surg. 2013;15(5):358-361. doi:10.1001/jamafacial.2013.344.
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Importance  Nasal airway obstruction is a common presenting symptom in otolaryngology and facial plastic surgery practices, and the potential for multiple contributing causes requires extensive evaluation.

Objective  To develop a classification system for nasal obstruction using a subjective, validated quality-of-life instrument.

Design, Setting, and Participants  Retrospective study of patients’ responses on the Nasal Obstruction Symptom Evaluation (NOSE) instrument performed from July 2011 through May 2012. All patients were seen at a university-based tertiary medical center.

Main Outcomes and Measures  Scores from patients with or without nasal obstruction were used to develop a classification system after receiver operating characteristic curve analysis. The classification subdivides nasal obstruction scores into a range of defined classes.

Results  Data analysis was performed using results from 345 patients. A score of 30 on the NOSE survey best differentiated patients with and without nasal obstruction. This threshold also provided intervals used to define the other class ranges. Patients were categorized as having mild (range, 5-25), moderate (range, 30-50), severe (range, 55-75), or extreme (range, 80-100) nasal obstruction, depending on responses on the NOSE survey.

Conclusions and Relevance  The NOSE scale is an important tool for gauging symptoms in patients with nasal obstruction. The proposed classification system will improve patient care by providing a framework for the severity of their symptoms and helping them understand potential treatment effects. If the classification is used in future outcomes research, it will allow physicians to better understand the study patient population and the effect of treatment on each severity class.

Level of Evidence  NA

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Figure 1.
Nasal Obstruction Symptoms Evaluation Instrument

This questionnaire is given to patients at their initial visit.

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Figure 2.
Histograms for Nasal Obstruction Symptom Evaluation (NOSE) Scale Scores

Scores from patients without (A) and with (B) a report of nasal obstruction are shown. Scores range from 0 to 100.

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