A Systematic Review of Patient-Reported Nasal Obstruction Scores

IMPORTANCE A gold standard objective measure of nasal airway obstruction (NAO) does not currently exist, so patient-reported measures are commonly used, particularly the Nasal Obstruction Symptom Evaluation (NOSE) scale and the visual analog scale (VAS). However, questions remain regarding how best to use these instruments. OBJECTIVES To systematically review studies on NOSE and VAS scores in patients with NAO and to compile and standardize the data to (1) define symptomatic and normative values for presurgical and postsurgical patients with NAO, asymptomatic individuals, and the general population; (2) determine if postsurgical scores are comparable with asymptomatic scores; and (3) determine if there is a clinically useful preoperative and postoperative score change. EVIDENCE REVIEW A systematic review of the literature was performed through PubMed for studies assessing NOSE and VAS scores in patients with chronic NAO. Strict inclusion criteria were applied to focus on anatomic obstruction only. For statistical analysis, the patients were classified as asymptomatic, presurgical and postsurgical with NAO, and the general population. FINDINGS The mean (SD) NOSE and VAS scores for a patient with NAO were 65 (22) and 6.9 (2.3), respectively. The mean postsurgical NOSE and VAS scores were 23 (20) and 2.1 (2.2), respectively. The mean asymptomatic individual NOSE and VAS scores were 15 (17) and 2.1 (1.6). The mean NOSE and VAS scores for the general population were 42 (27) and 4.6 (2.6), respectively. The mean presurgical to postsurgical change was more than 40 for NOSE scores and more than 4.0 for VAS scores. CONCLUSIONS AND RELEVANCE We have shown that normative and abnormal value ranges for NOSE and VAS can be established for clinical use. Given the consistency of both scales, we conclude that these measures can be used as a clinically meaningful measure of successful surgical outcomes.