A UK survey of current ENT practice in the assessment of nasal patency

Abstract

ObjectivesNasal obstruction is a common presentation in ENT practice, and yet decisions on its management are challenging, with high rates of patient and clinician dissatisfaction following surgery. The aim of the study was to investigate the practice of UK ENT clinicians in the subjective and objective evaluation of nasal patency. DesignVoluntary, written questionnaire. SettingBritish Academic Conference in Otolaryngology 2015, Liverpool, UK. Participants UK-based ENT professionals. Results UK based rhinologists were surveyed at the 2015 British Academic Conference inOtorhinolaryngology (BACO) from a cohort of 250 delegates attending two symposia on rhinology with a response rate of 78/250. Clinical history and examination were found to be almost universally used in the evaluation of nasal blockage. The most commonly used clinical test was the nasal misting pattern demonstration on a metal spatula (73%), followed by the peak nasal inspiratory flow rate (19%). The most commonly used subjective measure was the sinonasal outcome test (SNOT-22/23), with a 29% uptake.63% of the responders reported that non-availability of suitable equipment was the main reason for not using objective measures, followed by time consumption, and the lack of correlation with subjective symptom scores. ConclusionsOur study demonstrated that British clinicians rely largely on clinical skills to evaluate nasal blockage. There is a desire for a simple, practical, non-invasive device which a) objectively measures airflow during physiological resting nasal breathing, b) correlates with subjective symptom scores, and c) is capable of simultaneous measurement of each nostril.

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

“…The overall use of outcome measures in the routine assessment of nasal obstruction among ENT surgeons is low . Although PNIF and SNOT were the most frequently utilised tools, it was only used by 19% and 29% of the respondents respectively, in this UK survey.…”

The internal nasal valve: a validated grading system and operative guide

“…Ideally a consensus should be reached for a minimum dataset, much like thyroid surgery, to be recorded by all surgeons to allow comparison of outcomes. This concept was particularly borne out following a recent questionnaire evaluating current ENT practice in measuring nasal obstruction [11]. …”

The role of unilateral nasal inspiratory peak flow in nasal obstruction—A study of 70 patients undergoing septorhinoplasty surgery

“…The reasons for the poor uptake of AR and AAR in the UK were put down to their significant cost and also the additional required time to perform the test. 15 As a result, we did not use these alternative objective measurements in this study, although in future studies their application would further our understanding. In addition, a recent study has shown a reasonable correlation between unilateral NIPF and unilateral AAR in the measurement of unilateral nasal airflow and hence in the ENT secondary care setting NIPF would be considered more cost effective.…”