Unilateral Nasal Obstruction Causes Symptom Severity Scores Similar to Bilateral Nasal Obstruction

Abstract

The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p < 0.001). On multiple linear regression, total, left, and right septal deviation (p < 0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p < 0.001, p = 0.003, p < 0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.

Computational Fluid Dynamics Modeling of Nasal Obstruction and Associations with Patient-Reported Outcomes

“…2) were most commonly affected by septal deviation causing static obstruction of one side. Our group previously demonstrated that patients with unilateral septal deviation or internal nasal valve narrowing have symptoms similar 26 Although nasal resistance did not correlate with Nasal Obstructive Symptom Evaluation scores in the unilateral static obstruction cohort, we hypothesize that an improved correlation would be seen if nasal airway resistance was calculated for both right and left sides independently. Among patients with moderate or severe static nasal obstruction, our model demonstrated a significantly higher resistance and pressure drop across the nasal cavity in patients with bilateral symptoms as compared to those with unilateral symptoms.…”

Peak Nasal Inspiratory Flow (PNIF) for Nasal Breathing Evaluation

“…Weitzman et al demonstrated that unilateral nasal airway obstruction can significantly impair the sensation of nasal breathing, leading to a sensation of inadequate nasal breathing comparable to bilateral nasal obstruction. 26 Therefore, unilateral nasal airway obstruction may account for same cases of low correlation between bilateral PNIF value and patient's symptoms of nasal obstruction. Unilateral PNIF measurements are therefore warranted and may prove particularly useful when clinical assessment of the nasal airway detects a significant asymmetry between both nasal cavities.…”

“…Weitzman et al demonstrated that unilateral nasal airway obstruction can significantly impair the sensation of nasal breathing, leading to a sensation of inadequate nasal breathing comparable to bilateral nasal obstruction (26). Therefore, unilateral nasal airway obstruction may account for same cases of low correlation between bilateral PNIF value and patient's symptoms of nasal obstruction.…”

Algorithm for Nasal Breathing Impairment Evaluation

“…Weitzman et al demonstrated that unilateral nasal obstruction causes symptoms of breathing impairment identical to bilateral nasal obstruction. 22 Therefore, it is paramount that each nasal cavity is individually assessed looking for possible narrowing of the nasal airway. Separated measurement of nasal airway dimensions from each nasal cavity or measuring nasal airflow from each side of the nasal airway correlates better with patient-reported evaluation of nasal breathing than bilateral evaluation 23 and may, therefore, narrow the assessment process of these patients.…”