Correlation of nasal symptoms with objective findings and surgical outcome measurement
Thesis submitted for the degree of Master of Surgery, University of London, 1993.
Published (excluding Chapter 9) 1996.
Recompiled HTML format June 2007
© 1993 – 2014 JW Fairley
Mr James W Fairley BSc MBBS FRCS MS
Consultant ENT Surgeon
The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Nasal inspiratory peak flow and subjective sensation of nasal obstruction
- Chapter 1: General Introduction and historical review (full text)
- Chapter 2: Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate in healthy volunteers
- Chapter 3: Nasal pressure probe studies using a new device in healthy volunteers: Pressure applied to middle turbinate causes pain at lower threshold than inferior turbinate or nasal septum (full text)
- Chapter 4: Reliability and validity of a nasal symptom questionnaire for use as an outcome measure in clinical research and audit
- Chapter 5: The relationship between pain projected on a diagram of the face and systematically documented findings using rigid nasendoscopy
- Chapter 6: The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Nasal inspiratory peak flow and subjective sensation of nasal obstruction
- Chapter 7: The relationship between symptom scores on a specially designed questionnaire and corresponding objective measurements: Postnasal drip, rhinorrhoea, nasal obstruction, cough and mucociliary clearance time
- Chapter 8: The effect on symptoms of facial pain and headache of medical treatment and operations designed to remove endoscopically documented areas of mucosal contact between the turbinates and nasal septum
- Chapter 9: A prospective randomized controlled trial of Functional Endoscopic Sinus Surgery: Endoscopic middle meatal antrostomy versus conventional inferior meatal antrostomy. Interim results. (full text)
The relationship between subjective and objective nasal obstruction was studied using a Youlten Nasal Inspiratory Peak Flow meter in 133 patients attending a Nasal Research Clinic.
There were 56 men and 77 women.
Mean NIPF was 135 litres per minute in men, and 118 litres per minute in women (p = 0.023, unpaired 2 tailed t-test).
A highly significant inverse relationship (R = minus 0.264, Kendall’s Tau C = minus 0.22854, p = 0.0007) was demonstrated between the objective measurement of nasal inspiratory peak flow rate and the subjective degree of nasal obstruction on the 4-point ordinal scale used in the symptom questionnaire.
This relationship was valid in women when analyzed separately, but not in men.
The value of the relationship in predicting the degree of subjective nasal obstruction from the objective measurement is limited; overall it reduces error in prediction by 7.5%, in women 14% and nil in men (Goodman and Kruskall’s Lambda).
Therefore it is not reasonable to use nasal inspiratory peak flow as an objective equivalent of subjective nasal obstruction, particularly in men. The relationship accounts for only around 7% of the variation, and I have shown previously (Chapter 2) that the method itself has a coefficient of variation of 8%.
It would not be reasonable to say to an individual patient “Your test shows the nose is not blocked”.
Nor is it reasonable to use NIPF as a primary measure of outcome in nasal surgery, although it could be used as a secondary measure of technical success of treatment, bearing in mind its limited value in predicting subjective nasal obstruction.
Outcome measurement in surgery for nasal obstruction must therefore be based primarily on the subjective opinion of the patient.