Adaptation and validation of the Turkish version of the Nasal Obstruction Symptom Evaluation scale

Translation and validation of the Bahasa Malaysia version of the Nasal Obstruction Symptom Evaluation scale (M-NOSE)

Background

The Nasal Obstruction Symptom Evaluation (NOSE) is a questionnaire to assess patients with nasal obstruction. The aim of this study was to translate and validate NOSE to the Malay version NOSE (M-NOSE).

Methods

The NOSE questionnaire was translated to Malay language and back to English. Psychometric properties consisting of reliability, reproducibility, validity, responsiveness were appraised in patients with nasal obstruction due to deviated nasal septum and healthy asymptomatic controls.

Results

A total of 126 participants were recruited. There was significant difference between patients and controls for all items and the total score (all p < 0.001). The correlation was moderate to strong between all items and total score (r = 0.71 to 0.8) and fair to moderate for the inter-items correlations (r= 0.31 to 0.70). Internal consistency for M-NOSE was good (α = 0.81). The test-retest for each item demonstrated no significant difference. There was significant difference of the pre- and post-operative mean for each item and total score (all p < 0.001) with good response sensitivity (effect size, d = 4.91).

Conclusions

The M-NOSE has satisfactory reliability, internal consistency, reproducibility and responsiveness. It is a valid and convenient tool in the assessment of the impact and treatment outcome of nasal obstruction.

Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty

BACKGROUND

Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head.

METHODS

A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment.

RESULTS

A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported.

CONCLUSION

The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Role of Microplastics in Chronic Rhinosinusitis Without Nasal Polyps

OBJECTIVE

We aimed to examine the relationship between chronic rhinosinusitis without nasal polyps and microplastics.

METHODS

A total of 80 patients participated in this prospectively planned study. The patients were divided into two groups. Group 1 had 50 patients with chronic rhinosinusitis without nasal polyps, whereas Group 2 had 30 healthy volunteers. The age and gender of the participants were noted. Nose Obstruction Symptom Evaluation questionnaire was applied to the patients. The patients performed nasal lavage with saline. Microplastics were examined in the collected nasal lavage fluids, and their numbers were noted. The groups were compared on these values.

RESULTS

The mean age was 38.06 ± 14.15 years in the chronic rhinosinusitis group without nasal polyps and 33.60 ± 11.68 years in the control group. There was no significant difference between the groups in terms of age and gender. There was a significant difference in the number of microplastics between the chronic rhinosinusitis group without nasal polyps and the control group (p < 0.001). Microplastics were detected in all participants.

CONCLUSIONS

We found more microplastics in patients with chronic rhinosinusitis without nasal polyps. According to this result, we can say that there may be a relationship between chronic rhinosinusitis and microplastics.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1077-1080, 2024.

Translation and Validation of the Thai Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale

Objective

The Nasal Obstruction Symptom Evaluation (NOSE) was developed to evaluate subjective outcomes of patients with deviated nasal septum and symptomatic nasal obstruction. Considering the differences in individuals' cultural, cross-cultural translation, adaptation, and validation of the instrument are necessary. The current study aimed to translate and validate the Thai version of the NOSE Questionnaire for patients with nasal septum deviation.

Study Design

A single-center prospective instrument validation study.

Setting

Thai tertiary referral center.

Methods

The study was conducted to translate and adapt the original English version of the NOSE to Thai. After translating, psychometric testing was conducted. The primary outcomes were validity (content, construct, and discriminant), reproducibility (test-retest procedure), and internal consistency (reliability). A total of 105 participants, of which 46 were patients with nasal airway obstruction and 59 were healthy asymptomatic volunteers, were enrolled in this study.

Results

The Thai-NOSE was found to be adequate for all tested psychometric properties with high internal consistency (Cronbach's α = .942), and to discriminate accurately between patients and healthy controls. The interitem and item-total correlations indicated a related construct among all items. A high level of reproducibility of the questionnaire was obtained in the test-retest procedure for each item (γ = 0.898). The initial test and retest scores indicated adequate reproducibility.

Conclusion

The Thai-NOSE questionnaire is a reliable instrument with appropriate psychometric properties for assessing the severity and impact of nasal airway obstruction in patients with nasal septum deviation.

Validation of the Nasal Obstruction Symptom Evaluation Scale in Mexican Adults

BACKGROUND

Nasal obstruction is a feeling of impaired airflow through the nose, caused by diverse factors with high prevalence. There are numerous methods to study it, being the most important subjective instrument the Nasal Obstruction Symptom Evaluation score, NOSE, with good structural validity and internal consistency. It has been translated and validated in several languages, including European Spanish, but hasn't been validated in Mexico.

AIM

Adapt and validate the NOSE scale to the Spanish language for a Mexican adult population.

METHODS

This study was conducted from May-August 2015. The scale was translated from English to Spanish and assessed by two experts to confirm its acceptability, being retranslated later. Adult subjects with native Mexican Spanish were recruited from the outpatient clinic, with chronic rhinopathy and without evidence of respiratory pathology. Both groups filled the scale, and anthropometric data were collected. A subgroup completed the instrument again after one month. STATA 15.1 was used for analysis.

RESULTS

The sample were 261 subjects. Cronbach alpha was 0.89, intraclass correlation coefficient 0.84, agreement limits -9.62 to 16.29. There was a statistically significant difference in score between groups. The area under the ROC curve was 0.855, with 83% sensibility and 76% specificity for a 20 total score. Moderate to strong item-total association was found with Spearman. The response model showed moderate item discrimination. In the factorial analysis, one factor was found, with an Eigenvalue of 3.21.

CONCLUSION

The adaptation of the NOSE scale is reliable and valid for its application in Mexican adult population.

Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures

It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.

The Effect of Septoplasty on Endothelial Function in Patients With Marked Nasal Septal Deviation

BACKGROUND

It is known that nasal septal deviation (NSD) has negative effects on the cardiovascular system, but the possible pathophysiological mechanisms of these effects still need to be explained. The aim of this study was to investigate the endothelial dysfunction (ED) caused by NSD and the effects of septoplasty on it.

METHODS

The study included 40 patients between the ages of 18 to 50 years with a marked NSD indication for septoplasty and 40 healthy age-and gender-matched individuals. Nasal obstruction symptom evaluation scale was used to evaluate the severity of nasal obstruction and the effectiveness of septoplasty. All participants underwent detailed cardiac examination and ultrasonographic measurement of flow-mediated dilatation (FMD). The same cardiac evaluations and nasal obstruction symptom evaluation scale assessments were repeated in the patient group at the postoperative 3rd month.

RESULTS

The mean FMD value in the control group was significantly higher than preoperative FMD in the patient group (9.1 ± 2.9 versus 7.6 ± 2.4, P = 0.024). In the patient group, preoperative and postoperative FMD values were measured as 7.6 ± 2.4 and 9.0 ± 2.7, respectively, and there was a significant difference between them (P = 0.032). There was no significant difference in FMD values between the control group and postoperative patient group (P = 0.925).

CONCLUSIONS

This study shows that NSD can cause ED, which is a precursor of atherosclerosis, and that successful septoplasty can improve ED.

The Impact of Septoplasty on Cardiopulmonary Functions in Patients With Nasal Septal Deviation: A Prospective Comprehensive Analysis of Echocardiographic Outcome and Serum N-Terminal Pro BNP Levels

ABSTRACT

This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean [standard deviation] age: 33.7 [10.9] years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 [0.83] versus 1.87 [0.73], P < 0.001), and nose obstruction symptom evaluation scores (83.7 [4.9] versus 12.7 [(5.4], P < 0.001) from preoperative to postoperative period, while maximum effort capacity was improved significantly (11.8 [1.9] versus 13.1 [2.1], P = 0.010) after septoplasty. Echocardiography findings at 3rd postoperative month revealed significant decrease in pulmonary artery systolic pressure (22.2 [3.2] versus 19.0 [3.6], P = 0.001), whereas significant increase in trans-mitral early diastolic rapid filling (E wave, 0.82 [0.14] versus 0.87 [0.13], P = 0.011), peak systolic velocity (S, 0.11 [0.02] versus 0.12 [0.02], P = 0.002), tricuspid annular plane systolic excursion (22.6 [3.2] versus 24.9 [2.9], P = 0.002), and right ventricle stroke volume (0.14 [(0.02] versus 0.15 [0.02], P = 0.013). In conclusion, our findings indicate favorable outcome of septoplasty in NSD patients not only in terms of improved nasal airflow but also cardiopulmonary functions, particularly the exercise capacity, pulmonary artery pressure, and right ventricular systolic functions. In this regard, our findings emphasize the important role of treating NSD patients without delay, given the likelihood of septoplasty to reverse the changes in the pulmonary artery system and to prevent onset of permanent cardiopulmonary dysfunction via amelioration of chronic obstruction of the upper respiratory tract.

The Simplified Nasal Septal Deviation Evaluation System and Nasal Obstruction Symptom Evaluation Scale Correlation

Nasal septal deviation (NSD) is a common condition in otorhinolaryngology practice. The aim of this study was to investigate the possible relationship between localization and severity of NSD, and related complaints as well as to suggest a simplified assessment method for NSD. Seventy-five patients who complaint nasal obstruction were enrolled this study. The affected nasal cavity was divided into 4 separate sections as follows: antero-superior (AS), antero-inferior (AI), postero-superior (PS), and postero-inferior (PI). Each section was determined according to its relationship to the both superior edge and head of the inferior turbinate. The NSD score was calculated separately for each section according to its relationship with lateral nasal wall. The NSD-related complaints were assessed via the Nasal Obstruction Symptom Evaluation (NOSE) scale. There were 42 male and 33 female patients, with an age range of 18 to 44 years. The mean NSD score was 2.18 ± 0.63 for AS section, 1.92 ± 0.67 for AI section, 1.54 ± 0.70 for PS section, and 1.18 ± 0.60 for PI section. The mean total NSD score was 6.84 ± 1.97 while the mean NOSE score was 12.5 ± 5.11. There was a strong positive correlation between total NSD and NOSE scores when the NSD score was 6 or more (r = 0.9556). This correlation was also present when each section was evaluated separately. The strongest correlation was detected for AS section deviations. Our septal classification system provides a simple and effective evaluation of NSDs. The NSDs which affect internal valve are more related with nasal obstruction and patients' discomfort.

Comparison of nasal airway obstruction with sonoelastography and nose obstruction symptom evaluation scores in children with allergic rhinitis

Objective

Nasal airway obstruction caused by inferior turbinate hypertrophy is the most troublesome symptom for patients with allergic rhinitis. The aim of this study was to determine any correlation between different nasal obstruction measurements in children with allergic rhinitis.

Material and Methods

Nasal airway obstruction was assessed with Sonoelastography, Turkish version of the Nose Obstruction Symptom Evaluation scale, Rhinoconjunctivitis Total Symptom Score and visual analog scale methods in children with allergic rhinitis and the results were compared with a healthy control group.

Results

Evaluation was made of a total of 68 patients (40 boys and 28 girls [male: female ratio, 1.42]) with a mean age of 13.35±3.35 (range, 7-18) years. The Rhinoconjunctivitis Total Symptom Score, visual analog scale, and Turkish version of the Nose Obstruction Symptom Evaluation scale scores were significantly higher in the AR group than in the control group (p=0.001, p=0.001, p=0.001, respectively). The sonoelastography scores were significantly higher in the AR group than in the control group (p=0.001). Although a positive significant correlation was determined between Rhinoconjunctivitis Total Symptom Score, visual analog scale, and Turkish version of the Nose Obstruction Symptom Evaluation scale scores in terms of AR severity, no relationship was found with the sonoelastography scores (p=0.022, p=0.009, p=0.001, and p=0.0751, respectively).

Conclusion

The Turkish version of the Nose Obstruction Symptom Evaluation scale and sonoelastography can be used to evaluate nasal obstruction due to inferior turbinate hypertrophy in children with allergic rhinitis.

The systolic pulmonary artery pressure and the E/e' ratio decrease after septoplasty in patients with grade 2 and 3 pure nasal septal deviation

INTRODUCTION

Nasal septal deviation may contribute to a wide range of symptoms including nasal obstruction, headache, increased secretion, crusting, mucosal damage, and loss of taste and smell. Excessive increase in the respiratory resistance, as seen in nasal septal deviation, results in reduced lung ventilation, thereby potentially leading to hypoxia, hypercapnia, pulmonary vasoconstriction. The deformities in the nasal cavity can be associated with major respiratory and circulatory system diseases.

OBJECTIVE

To investigate cardiovascular effects of septoplasty by comparing pre- and postoperative transthoracic echocardiography findings in nasal septal deviation patients undergoing septoplasty.

METHODS

The prospective study included 35 patients with moderate and severe nasal septal deviation (mean age, 23.91±7.01) who underwent septoplasty. The Turkish version of the nasal obstruction symptom evaluation, NOSE questionnaire, was administered to each participant both pre- and postoperatively in order to assess their views on the severity of nasal septal deviation, the effect of nasal obstruction, and the effectiveness of surgical outcomes. A comprehensive transthoracic echocardiography examination was performed both preoperatively and at three months postoperatively for each patient and the findings were compared among patients.

RESULTS

Mean preoperative NOSE score was 17.34±1.62 and the mean postoperative score was 2.62±1.68 (p=0.00). Mean preoperative systolic pulmonary artery pressure value was 22.34±4.31mmHg and postoperative value was 18.90±3.77mmHg (p=0.00). Mean E/e' ratio was 5.33±1.00 preoperatively and was 5.01±0.90 postoperatively (p=0.01). The NOSE scores, systolic pulmonary artery pressure values, and the E/e' ratios decreased significantly after septoplasty (p<0.05 for all), whereas no significant difference was found in other transthoracic echocardiography parameters (p>0.05).

CONCLUSION

The decrease in NOSE scores following septoplasty indicated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to nasal septal deviation may be a cardiovascular risk factor and may affect transthoracic echocardiography measurements. Moreover, the significant decrease in the systolic pulmonary artery pressure value and E/e's ratio following septoplasty indicated that negative echocardiographic findings may be prevented by this surgery.

Does septoplasty affect 24-h ambulatory blood pressure measurements in patients with type 2 and 3 pure nasal septal deviation?

PURPOSE

To investigate day, night and 24 h all blood pressure effects of septoplasty by comparing pre- and post-operative 24-h ambulatory blood pressure monitoring (ABPM) values of NSD patients undergoing septoplasty.

MATERIALS AND METHODS

The prospective study included 20 patients with type 2 and 3 pure NSD (mean age, 23.60 ± 6.51) who underwent septoplasty in our clinic. Nasal obstruction symptom evaluation (NOSE) questionnaire was applied to each participant both pre- and post-operatively to evaluate their views on the severity of NSD and the effectiveness of surgical outcomes. A comprehensive ABPM examination was performed both 2 days before surgery and at three months postoperatively for each patient and the findings were compared among patients.

RESULTS

Preoperative NOSE score was 87.75 ± 7.34% and the postoperative score was 12.50 ± 6.58% (p = 0.000). Following septoplasty, 24-h systolic blood pressure (24SBP) declined from 119.4 ± 9.9 mmHg to 112.2 ± 8.0 mmHg (p = 0.000), daytime SBP (DSBP) declined from 125.9 ± 11.0 mmHg to 117.9 ± 8.4 mmHg (p = 0.000), nighttime SBP (NSBP) declined from 112.7 ± 9.5 mmHg to 105.5 ± 7.9 mmHg (p = 0.000), 24-h pulse pressure (24PP) declined from 46.7 ± 10.1 mmHg to 44.0 ± 8.4 mmHg (p = 0.015), and mean daytime PP (DPP) declined from 46.9 ± 9.7 mmHg to 44.6 ± 8.6 mmHg (p = 0.026).

CONCLUSION

The decline in NOSE percentages following septoplasty demonstrated that the satisfaction levels of the patients were increased. Upper airway obstruction secondary to NSD may affect ABPM measurements. Moreover, the significant decrease in the 24SBP, DSBP, NSBP, 24PP and DPP following septoplasty showed that NSD may cause cardiovascular risk and this risk may be prevented by septoplasty.

Evaluation of Measurement Properties of Patient-Reported Outcome Measures After Rhinoplasty: A Systematic Review

Importance

The number of available rhinoplasty outcome measurement instruments has increased rapidly over the past years. A large heterogeneity of instruments of different quality now exists, causing difficulty in pooling and comparing outcome data.

Objective

To critically appraise, summarize, and compare the measurement properties of all patient-reported outcome measures (PROMs) that measure functional or aesthetic symptoms of patients undergoing rhinoplasty, using consensus-based methodology and guidelines. This facilitates an evidence-based recommendation on the most suitable instrument to measure rhinoplasty outcomes and identifies promising instruments worthy of further research.

Evidence Review

A systematic literature search of Embase, Medline, and Web of Science was conducted from the databases' respective inception dates to May 18, 2018. Thirty-three articles evaluating 1 or more measurement properties of instruments measuring symptoms related to nasal breathing or satisfaction with nasal appearance in patients who had undergone septoplasty and/or rhinoplasty were included. Measurement properties were graded according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for systematic reviews of PROMs.

Findings

The search strategy identified 33 studies that used 12 different measurement instruments. In general, high-quality studies on measurement properties of instruments measuring aesthetic and/or functional symptom-specific outcome of rhinoplasty are scarce. The Nasal Obstruction Symptom Evaluation (NOSE) scale demonstrated high-quality evidence for sufficient structural validity, internal consistency, reliability, construct validity, and responsiveness, along with favorable interpretability and feasibility aspects, and was therefore selected as the most suitable instrument to measure functional outcome. Among instruments measuring aesthetic outcome, the FACE-Q and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) aesthetic subscale are recommended for further study. Future studies on the measurement properties of the identified PROMs, in particular content validity studies, are necessary.

Conclusions and Relevance

Three instruments with high potential for further use were identified in a systematic review of rhinoplasty outcome instruments using a standardized, consensus-based methodology: the NOSE, FACE-Q, and SCHNOS. These findings may contribute to standardized collection of outcome data in rhinoplasty.

Does surgical treatment of nasal airway obstruction improve sexual functions?

OBJECTIVE

To investigate the effects of surgical treatment for nasal obstruction on sexual functions, regardless of the condition causing the nasal obstruction.

METHODS

Of 238 patients identified with nasal obstruction, 57 complained of erectile dysfunction and were included in the analysis. Patients underwent septoplasty, functional endoscopic sinus surgery, concha bullosa excision or radiofrequency ablation of the inferior turbinates, depending on their obstruction-causing disease. Pre- and post-operative evaluation of perceived nasal obstruction was performed using the Nasal Obstruction Symptom Evaluation questionnaire. Pre- and post-operative assessment of sexual functions was performed using the International Index of Erectile Function.

RESULTS

Mean post-operative scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction were significantly higher compared to the pre-operative scores (p = 0.022, p = 0.036, p = 0.033, p = 0.016 and p = 0.029, respectively).

CONCLUSION

Surgical treatment of nasal obstruction by septoplasty, endoscopic sinus surgery, concha bullosa excision or radiofrequency can significantly improve sexual performance.

Validation of Patient-Reported Outcomes for Clinical Trials in Allergic Rhinitis: A Systematic Review

Although regulatory authorities have recently recommended the use of a combined symptom-medication score as a primary efficacy end point, none has been psychometrically validated. Here, we sought to determine to what extent allergic rhinitis (AR)-related patient-reported outcomes (symptom scores, medication scores, disease control scores, and satisfaction or quality-of-life scales) have been assessed for construct, content, and/or criterion validity, reliability, responsiveness, and the minimal clinically important difference. We searched the PubMed database from January 1997 to June 2018 with logical combinations of key words related to validation, AR, and patient-rated outcomes and scales. From a total of 1705 potentially relevant publications, 55 were reviewed. Despite the current emphasis on a combined symptom-medication score for evaluating the efficacy of allergen immunotherapy in AR, symptom scores have not been extensively validated, and we did not find any publications describing the validation of a medication score. Disease control scales (mainly the Rhinitis Control Assessment Test, the Control of Allergic Rhinitis and Asthma Test, and the Allergic Rhinitis Control Test) and health-related quality-of-life scales (mainly the Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and the mini-RQLQ) have been extensively validated in AR but have some practical disadvantages as primary efficacy criteria in clinical trials.

Adaption and validation of the nasal obstruction symptom evaluation scale in German language (D-NOSE)

Background

Questionnaires have proven their worth in detecting changes in quality of life after medical interventions. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable and valid tool to identify restrictions of quality of life in patients with nasal problems. The aim of this prospective study was the validation of the German version of the NOSE scale (D-NOSE).

Methods

Adaption of the NOSE in German language was performed by forward and backward translation process. Patients undergoing functional septorhinoplasty were asked to complete the D-NOSE preoperatively, one, three or twelve months after surgery. Healthy volunteers served as controls. Reliability, validity and responsiveness of the D-NOSE were determined.

Results

The D-NOSE showed a good internal consistency as well as good inter-item, item-total correlation and a satisfactory test-retest reliability. The convincing validity of the adapted NOSE scale was approved by good construct validity and an excellent discriminant validity. Furthermore, a high sensitivity to identify clinical changes due to an intervention indicates a good responsiveness of the D-NOSE.

Conclusions

The adapted German version of the NOSE questionnaire (D-NOSE) is an appropriate and validated tool to assess the influence of nasal obstruction in quality of life in German speaking patients.

Adaption and validation of the nasal obstruction symptom evaluation scale in German language (D-NOSE)

BACKGROUND

Questionnaires have proven their worth in detecting changes in quality of life after medical interventions. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable and valid tool to identify restrictions of quality of life in patients with nasal problems. The aim of this prospective study was the validation of the German version of the NOSE scale (D-NOSE).

METHODS

Adaption of the NOSE in German language was performed by forward and backward translation process. Patients undergoing functional septorhinoplasty were asked to complete the D-NOSE preoperatively, one, three or twelve months after surgery. Healthy volunteers served as controls. Reliability, validity and responsiveness of the D-NOSE were determined.

RESULTS

The D-NOSE showed a good internal consistency as well as good inter-item, item-total correlation and a satisfactory test-retest reliability. The convincing validity of the adapted NOSE scale was approved by good construct validity and an excellent discriminant validity. Furthermore, a high sensitivity to identify clinical changes due to an intervention indicates a good responsiveness of the D-NOSE.

CONCLUSIONS

The adapted German version of the NOSE questionnaire (D-NOSE) is an appropriate and validated tool to assess the influence of nasal obstruction in quality of life in German speaking patients.

Does Nasal Septal Deviation Affect the Eustachian Tube Function and Middle Ear Ventilation?

Objective

Our aim is to evaluate the effect of nasal septal deviation on the middle ear pressure and Eustachian Tube (ET) functions with regard to the side of deviation.

Methods

A prospective randomized clinical trial was conducted. Overall, 50 patients (22 female, 28 male) undergoing septoplasty because of nasal septum deviation were included. The nasal obstruction symptom evaluation (NOSE) scale was used to evaluate surgical satisfaction. Middle ear ventilation and the ET functions of a total of 100 ears were assessed with basal tympanometry and insufflation tests (Valsalva and Toynbee). The tests were performed on the operation day and eight weeks after surgery. The ears were divided into two groups: the affected side (the side of nasal obstruction) (Group 1) and the contralateral side (Group 2). The study parameters obtained before and after septoplasty were compared.

Results

The NOSE scores decreased after septoplasty (12.48±4.78/7.56±3.4) (p<0.001). There were 20 functional ETs (40%) in the affected side preoperatively, which increased to 36 ears (72%) postoperatively, and functional tubes increased to 35 (70%) from 29 (58%) after surgery in the contralateral side. The changes in the tympanometry results were statistically significant for both the affected side (-33.56 daPA/-21.18 daPA) and contralateral side (29.24daPA/-24.96daPA) (p<0.05), but the alteration in the side of deviation was more evident.

Conclusion

Our study shows that septoplasty may have a beneficial effect on middle ear ventilation and ET functions.