title: Axial computed tomography evaluation of the internal nasal valve correlates with clinical valve narrowing and patient complaint.
abstract: BACKGROUND
  The objective of this work was to explore the utility of axial computed tomography (CT) imaging to objectively define a narrow internal nasal valve, and compare those findings with clinical examination and patient complaint.
  
  
  METHODS
  Retrospective review from a single facial plastic surgery center. We reviewed 40 consecutive patients evaluated for either sinusitis or nasal airway obstruction for which a CT scan was obtained at a single radiology institution. Thirty-six complete office records were examined for the presence of clinical internal valve narrowing and complaints of nasal obstruction. In total, 72 internal nasal valves were analyzed using axial plane CT and measurements were compared to clinical findings and presence of airway obstruction.
  
  
  RESULTS
  Measured valve areas for clinically normal internal nasal valves averaged 0.47 cm(2) vs 0.28 cm(2) for clinically narrow valves, a decrease of 40.4%. In unobstructed nasal airways the valve area averaged 0.51 cm(2) vs 0.38 cm(2) in obstructed airways, a difference of 25.5%. A radiographically measured valve area of <0.30 cm(2) suggests clinical narrowing with a sensitivity of 71.4%, specificity of 88.9%, positive predictive value of 62.5%, and negative predictive value of 92.3%.
  
  
  CONCLUSIONS
  Using standard axial CT imaging we describe an objective method of radiographically evaluating the nasal valve, demonstrating strong correlation with physical examination and patient complaint. Additionally, radiographic valve areas can be used to screen for clinically narrow nasal valves with good sensitivity and specificity, providing a novel straightforward method for nasal valve assessment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY
authors.forename: Jason A
authors.initials: JA
authors.lastname: Moche
authors.forename: Justin C
authors.initials: JC
authors.lastname: Cohen
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Pearlman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000000981:diagnostic imaging* / Q000473:pathology; D009666:Nose / Q000000981:diagnostic imaging / Q000473:pathology; D012852:Sinusitis / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult