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

Published online by Cambridge University Press:  07 August 2013

D Chin ,
J Malek ,
E Pratt ,
G Marcells ,
R Sacks  and
R J Harvey
D Chin*
Affiliation:
Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia Department of Otolaryngology, Head & Neck Surgery, Changi General Hospital, Singapore
J Malek
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia
E Pratt
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia
G Marcells
Affiliation:
Bondi Junction Private Hospital, Sydney, Australia Department of Otolaryngology, Sydney Hospital, Sydney, Australia
R Sacks
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, Sydney, Australia Department of Otolaryngology, Macquarie University Hospital, Sydney, Australia
R J Harvey
Affiliation:
Faculty of Medicine, University of Sydney, Sydney, Australia Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
*
Address for correspondence: Dr David Chin, 354 Victoria Street, Darlinghurst, NSW, Australia2010 Fax: +61 (0)2 9360 9919 E-mail: drdavidchin@gmail.com
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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.

Keywords

Nasal ObstructionNasal SeptumRhinomanometryNasal Surgical ProceduresTurbinates
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Supplement S1 , January 2014 , pp. S34 - S39
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

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.

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