Minimal unilateral peak nasal inspiratory flow correlates with patient reported nasal obstruction

Volstad, I; Olafsson, Thorarinn Arnar; Steinsvik, Eivind Andreas Svaboe; Dahl, Fredrik A.; Skrindo, I.; Bachmann-Harildstad, Gregor

doi:10.4193/rhin19.178

Cited by 9 publications

(12 citation statements)

References 20 publications

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“…This study found a statistically significant but weak correlation between patient‐reported evaluation of nasal breathing and objective measurement of nasal airflow in patients not selected according to symptoms of nasal obstruction or to the level of nasal airflow. This finding is consistent with other studies that evaluated patients with nasal airway obstruction and found a statistically significant but weak correlation between PNIF level and NOSE or VAS score 34‐40 …”

Section: Discussionsupporting

confidence: 92%

Objective measurement and patient‐reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow?

Xavier

Azeredo‐Lopes

Menger

et al. 2021

Clinical Otolaryngology

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Background Evidence has shown that the sensation of nasal breathing is related to variations in nasal mucosa temperature produced by airflow. An appropriate nasal airflow is necessary for changing mucosal temperature. Therefore, the correlation between objective measurements of nasal airflow and patient‐reported evaluation of nasal breathing should be dependent on the level of nasal airflow. Objectives To find if the correlation between patient‐reported assessment of nasal breathing and objective measurement of nasal airflow is dependent on the severity of symptoms of nasal obstruction or on the level of nasal airflow. Methods The airway of 79 patients was evaluated using NOSE score and peak nasal inspiratory flow (PNIF). Three subgroups were created based on NOSE and three subgroups were created based on PNIF level to find if correlation was dependent on nasal symptoms or airflow. Results The mean value of PNIF for the 79 patients was 92.6 L/min (SD 28.1 L/min). The mean NOSE score was 48.4 (SD 24.4). The correlation between PNIF and NOSE was statistically significant (P = .03), but with a weak association between the two variables (r = −.248). Evaluation of correlation based on symptoms demonstrated a weak or very weak association in each subgroup (r = −.250, r = −.007, r = −.104). Evaluation of correlation based on nasal airflow demonstrated a very weak association for the subgroups with middle‐level and high PNIF values (r = −.190, r = −.014), but a moderate association for the subgroup with low PNIF values (r = −.404). Conclusions This study demonstrated a weak correlation between NOSE scores and PNIF values in patients non‐selected according to symptoms of nasal obstruction or to airflow. It demonstrated that patients with symptoms of nasal obstruction have different levels of nasal airflow and that low nasal airflow prevents the sensation of good nasal breathing. Therefore, patients with symptoms of nasal obstruction may require improving nasal airflow to improve nasal breathing sensation.

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Section: Discussionsupporting

confidence: 92%

Objective measurement and patient‐reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow?

Xavier

Azeredo‐Lopes

Menger

et al. 2021

Clinical Otolaryngology

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“…A total 5 out of 8 studies identified a correlation between PNIF and PROMs in AR and CRS. The strength of correlation was weak in the majority of the included papers (0.35 < r < 0.5) 17,42,44,59,60 ; however, stronger correlation was noted in CRS patients ( r > 0.5) 17,50,58 . The only publication in the DNS population found no statistically significant correlation between PNIF and PROMs, post‐septorhinoplasty.…”

Section: Resultsmentioning

confidence: 95%

“…For nasal obstruction, the most commonly studied PROM was the visual analogue scale (VAS) for nasal obstruction which was used in 45% of the included studies 17,36,40,41,44,48–50,52–60 . Only 25% of the included papers used the validated NOSE questionnaire for nasal obstruction 30,31,35,46,48,50,61,62 .…”

Section: Resultsmentioning

confidence: 99%

“…Because the NOSE questionnaire was only validated as a PROM for nasal obstruction due to a deviated septum for patients undergoing septoplasty in 2004, 63 studies conducted prior to 2004 would not have been able to use the questionnaire. Nevertheless, a large number of studies conducted after 2004 opted not to utilize the NOSE questionnaire 17,19,29,35,40–42,44,48,50,53–60 …”

Section: Resultsmentioning

confidence: 99%

“…The SNOT‐22 67 was used in 83% of the included papers, 20,21,23,24,26,34,40,45,60,68–73 with VAS used in 10 out of 18 papers, 20,26,40,59,60,65,71,72,74 and SNOT‐22 was used to correlate with rhinoscintigraphy results 33,34 …”

Section: Resultsmentioning

confidence: 99%

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A systematic review to examine the relationship between objective and patient‐reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice

Philpott

2021

Int Forum Allergy Rhinol

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Background Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient‐reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations. Methods A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis. Results In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5). Conclusion Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.

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Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

Zhang

Miglani

et al. 2021

Am J Rhinol�Allergy

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Background Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow. Objective To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow. Methods A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis. Results Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90; P = .002) and PNIF (MD 13.31 L/min [ P = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36; P < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65; P < .001], with a trend toward improvement in TNSS. Conclusion Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.

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Minimal unilateral peak nasal inspiratory flow correlates with patient reported nasal obstruction

Cited by 9 publications

References 20 publications

Objective measurement and patient‐reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow?

Objective measurement and patient‐reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow?

A systematic review to examine the relationship between objective and patient‐reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice

Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis

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