title: Correlations between acoustic rhinometry, subjective symptoms, and endoscopic findings in symptomatic children with nasal obstruction.
abstract: OBJECTIVE
  Nasal obstruction is common in children and difficult to quantify objectively. Symptom quantification is paramount for surgical and medical decision making. Acoustic rhinometry is a relatively new technique aimed at the objective assessment of nasal obstruction. There is no standardized method for the objective assessment of the pediatric nasal airway.
  
  
  OBJECTIVE
  To explore the correlations between acoustic rhinometry (AR), subjective symptoms, and endoscopic findings in children presenting with nasal obstruction.
  
  
  METHODS
  A cross-sectional, exploratory, diagnostic study of prospectively collected data from a multidisciplinary airway clinic (pulmonology, orthodontics, and otolaryngology) database at a tertiary academic referral center. Data were collected over a 2-year period (2010-2012) from 65 nonsyndromic children (38 boys) 7 years and older (mean [SD] age, 10.3 [2.5] years [range, 7-14 years]), presenting with persistent nasal obstructive symptoms for at least 1 year, without signs and symptoms of sinus disease.
  
  
  METHODS
  We collected patient demographics and medical history information including allergy, asthma, and sleep-disordered breathing. Subjective nasal obstruction was scored using a visual analog scale (VAS). Sleep-disordered breathing was assessed using overnight pulse oximetry. The adenoid size, septal position, and visual severity of chronic rhinitis (endoscopic rhinitis score [ERS]) were rated on nasal endoscopy by 2 independent reviewers and validated by agreement. Acoustic rhinometry (AR) was undertaken before and after use of a decongestant.
  
  
  METHODS
  Correlation and multiple regression analyses were performed to explore interrelationships between subjective nasal obstruction VAS, AR, and nasal endoscopy.
  
  
  RESULTS
  Among the 65 patients, 28 (43%) had symptoms of sleep-disordered breathing, 14 (22%) had allergic rhinitis, 10 (15%) had asthma, 27 (41%) had grade 3 or 4 adenoidal obstruction, 28 (43%) had an ERS of 2, 6 (9%) had an ERS of 3, and 19 (29%) had septal deviation. Significant correlations were found between subjective nasal obstruction VAS score and ERS (r = -0.364, P = .003), ERS and minimal cross-sectional area before decongestion (r = -0.278, P = .03), and adenoid size and calculated nasal resistance after decongestion (r = 0.430, P < .001). Multiple regression analysis showed that the ERS was the only significant predictor of VAS score (β of -22.089; 95% CI, -35.56 to -8.61 [P = .002]). No predictors were identified for AR variables.
  
  
  CONCLUSIONS
  Among the evaluated tools, endoscopy appears to be the most reliable tool to estimate the degree of subjective nasal symptoms.
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: Andre
authors: A
authors: Isaac
authors: Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Michael
authors: M
authors: Major
authors: Division of Pediatric Pulmonology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors: Manisha
authors: M
authors: Witmans
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada4Division of Pediatric Surgery, Department of Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors: Yaser
authors: Y
authors: Alrajhi
authors: Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Carlos
authors: C
authors: Flores-Mir
authors: Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Paul
authors: P
authors: Major
authors: Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Noura
authors: N
authors: Alsufyani
authors: Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors: Mohamed
authors: M
authors: Korayem
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada4Division of Pediatric Surgery, Department of Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors: Hamdy
authors: H
authors: El-Hakim
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology; D015984:Causality; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D015508:Nasal Obstruction / Q000175:diagnosis* / Q000453:epidemiology; D057605:Natural Orifice Endoscopic Surgery; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D065631:Rhinitis, Allergic / Q000175:diagnosis / Q000453:epidemiology; D023842:Rhinometry, Acoustic; D017678:Sex Distribution; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology