What are the clinically important outcome measures in the surgical management of nasal obstruction?

Abstract

Objectives

to assess the correlation between the Nasal Obstruction Symptom Evaluation (NOSE) scale and peak nasal inspiratory flow (PNIF) measurement, and to determine which outcome variable correlates with patient satisfaction and thereby, successful surgical outcome.

Design

Prospective case series.

Setting

Rhinology practice in a tertiary referral centre (Liverpool, U.K).

Participants

Patients having surgery (septoplasty, turbinoplasty) for nasal obstruction.

Main outcome measures

NOSE, PNIF, 5-point Likert scale (weighted from "very satisfied" to "not at all satisfied") and a 10 cm visual analogue scale (0 = not at all satisfied, 10 = very satisfied).

Results

Forty-five (15 female) had complete datasets available for analysis. The mean pre-operative NOSE score was 78.4 (standard deviation, SD 14.8) and improved significantly to 23.0 (SD 19.1) post-operatively. A similar trend was observed where the mean pre-operative PNIF improved significantly by 40% from 91.8L/min (SD 28.2) to 139.9 (SD 27.9) following surgery. The mean improvement in NOSE score of the overall study cohort was 55.4 (SD 22.3) while the mean improvement in PNIF was 48.0 (SD 31.1). Although no correlation was observed between pre- and post-operative NOSE and PNIF, a significant (p = 0.01) but weak positive correlation (r = 0.39) was observed between the magnitude of change in NOSE and PNIF. The mean change in NOSE score of patients who were "very satisfied" with their nasal operation was 64.0 (SD 18.5), significantly higher compared to 39.2 (SD 17.9) in patients who were "satisfied".

Conclusions

Patients who rate being either "satisfied" or "very satisfied" demonstrated significant improvement in NOSE and PNIF following their nasal surgery; the magnitude being twice the calculated minimal clinically important difference.

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