Measures of the Nasal Airway
Development and Validation of the Nasal Obstruction Symptom
Evaluation (NOSE) Scale
Principal Investigator: Michael G. Stewart, MD, MPH,
Co- Investigators: David L. Witsell, MD, MHS; Timothy L. Smith, MD, MPH; Edward
M. Weaver, MD, MPH; Bevan Yueh, MD, MPH; Maureen T. Hannley, PhD
Otolaryngology- Head& Neck Surger 2004;130:157-63
Objective- The study goal was to validate a disease-specific health status instrument for
use in patients with nasal obstruction.
Design, Setting, and Patients- The study consisted of a prospective instrument validation
conducted at 4 academic medical centers with 32 adults with nasal septal deformity.
Methods- Prospective instrument validation occurred in 2 stages. Stage 1 was the
development of a preliminary (alpha-version) instrument of potential items. Stage 2 was a
test of the alpha-version for item performance, internal consistency, and test-retest
reliability; construct, discriminant, criterion validity, and responsiveness; and creation of
the final instrument.
Results- Items with poor performance were eliminated from the alpha-version
instrument. In testing the final instrument, test-retest reliability was adequate at 0.702;
internal consistency reliability was also adequate at 0.785. Validity was confirmed using
correlation and comparison analysis, and response sensitivity was excellent.
Conclusions- The Nasal Obstruction Symptom Evaluation Scale is a valid, reliable, and
responsive instrument that is brief and easy to complete and has potential use for
outcomes studies in adults with nasal obstruction.
Article: Development and Validation of the Nasal Obstruction Symptom Evaluation
(NOSE) Scale (Link to sdarticle.pdf file)
Acoustic Rhinometry Reliability
Principal Investigator: Edward M. Weaver, MD, MPH
Co-Investigator: Judy Stenstrom LPN, BA
This study confirms the inter-rater and test-retest reliabilities of minimum cross-sectional
area measurements of the nasal airway using acoustic rhinometry.
Methods- Two separate examiners measured minimum cross-sectional area with acoustic
rhinometry on 25 normal volunteers on three consecutive days. Intraclass correlation
coefficients were calculated.
Results- The overall mean minimum cross-sectional area was 0.61 ± 0.20 cm2, consistent
with published norms. Inter-rater correlation was 0.83. Test-retest correlations over 15minute, one-day, and two-day intervals were 0.80, 0.74, and 0.57, respectively.
Decreased test-retest correlation over two days likely represents gradual real change in
the intranasal dimensions.
Interpretation- Acoustic rhinometry has good to excellent reliability.
Comparison of Anatomic, Physiologic, and Subjective Measures of the
Nasal Airway
Principal Investigator: Derek J. Lam, MD
Co-Principal Investigator: Edward M. Weaver, MD, MPH
Co-Investigator: Kathryn T. James, PA, MPH
American Journal of Rhinology (in press)
Background- Studies comparing different categories of nasal measures have reported
inconsistent results. We sought to compare validated measures of the nasal airway:
anatomic (acoustic rhinometry), physiologic (nasal peak inspiratory flow), and subjective
experience (Nasal Obstruction Symptom Evaluation Scale and a visual analog scale).
Methods- This prospective cross-sectional study of 290 non-rhinologic patients included
upright and supine rhinometry (minimum cross sectional area and volume) and flow
(mean and maximum) measurerments, as well as subjective measures. Associations
between measures were evaluated with Spearman correlations and multivariate linear
regression, adjusting for age, sex, race, body mass index, and smoking history.
Results- Correlations between objective (rhinometry and flow) and subjective categories
of nasal measures ranged from -0.16 to 0.03 (mean correlation -0.07±0.05), with 0
significant correlations of 16 tested. Correlations between anatomic (rhinometry) and
physiologic (flow) categories ranged from 0.04 to 0.15 (mean correlation 0.10±0.03),
with 0 significant correlations of 16 tested. In contrast, within each category (rhinometry,
flow, and subjective), all correlations were significant (13 correlations, all p<0.001) and
ranged from 0.62 to 0.99. Of 16 adjusted associations between objective and subjective
measures, 14 were not significant (p>0.05); only uppright and supine minimum cross
sectional area were significantly associated with the visual analog scale (both p<0.05).
Conclusions- Validated anatomic, physiologic, and subjective nasal measures may assess
different aspects of the nasal airway and provide complementary information. Future
studies should aim to develop a composite measure including components from all three
categories of nasal measurement.
Development of a Composite Measure of the Nasal Airway
Principal Investigator: Derek J. Lam, MD
Co-Principal Investigator: Edward M. Weaver, MD, MPH
Co-Investigators: Kathryn T. James, PA, MPH; Danna Lei, BS; Aliya Hashemi BS;
Benjamin Reed
Sponsor: American Academy of Otolaryngology-Head & Neck Surgery
Objectives- 1) Develop a composite measure of the nasal airway including objective and
subjective validated parameters.
2) Validate the composite measure in an independent sample of patients.
Background- Acoustic rhinometry and nasal peak inspiratory flow are validated methods
for measuring anatomic and functional aspects of the nasal airway. The Nasal
Obstruction Subjective Evaluation (NOSE) scale is a validated measure of the subjective
experience of nasal airway obstruction and a visual analog scale is another means of
measuring subjective nasal obstruction. Our preliminary data indicate that the objective
nasal parameters do not correlate with the subjective measures of nasal obstruction,
suggesting they may measure different aspects of the nasal airway. We hypothesize that a
composite measure will be a more sensitive and responsive measure of the nasal airway
compared to any single measure.
Study design- Prospective cohort study of 300 consecutive new sleep apnea patients
being evaluated with multiple nasal measures at baseline and followed for CPAP use.
Instrument will be developed with first 200 patients and validated with next 100 patients.
Methods- The instrument will be developed using 1) multivariable linear regression
analysis to develop a multivariable model, and 2) conjunctive consolidation to create a
three-stage “nasal obstruction index,” using components of the NOSE scale, nasal
obstruction visual analog scale, physician nasal exam, acoustic rhinometry parameters,
and nasal flow parameters that are most strongly associated with nasal outcomes. These
components will be combined in a single composite score (linear regression model) or a
three-stage index (conjunctive consolidation), and each will be tested in an independent
sample for hypothesized associations between the nasal airway and other relevant
variables.
Conclusion- A composite score will represent a more comprehensive measure of the
nasal airway compared to any single measure. We predict such a measure will offer
superior prognostication of nasal outcomes and will have broad applications in
otolaryngology and related fields.