title: Non-invasive Assessment and Symptomatic Improvement of the Obstructed Nose (NASION): a physiology-based patient-centred approach to treatment selection and outcomes assessment in nasal obstruction.
abstract: OBJECTIVE
  To evaluate the impact of selecting treatment for nasal obstruction on the basis of a structured physiology-based assessment protocol on patient outcomes.
  
  
  METHODS
  Prospective longitudinal study.
  
  
  METHODS
  District general hospital.
  
  
  METHODS
  A population of 71 patients with a mean age of 33 years, containing 36 males, presented with nasal obstruction for consideration of nasal surgery. All patients underwent a structured clinical assessment, skin prick allergy testing and oral-nasal flow-volume loop examination. Fifty-one patients completed the follow-up, and mean follow-up was 11 months.
  
  
  METHODS
  NOSE, SNOT-22 and NASION scales.
  
  
  RESULTS
  Of the 51 patients who completed follow-up, six had conservative treatment, 28 had septal/turbinate surgery, and 17 underwent nasal valve surgery. Mean NOSE score fell from 68 ± 18 to 39 ± 31 following the treatment. Mean SNOT-22 score fell from 47 ± 20 to 29 ± 26 following the treatment. The difference between pre-treatment and post-treatment NOSE and SNOT-22 scores were statistically significant. Success rate of septal/turbinate surgery in patients without nasal allergy was 88%, and this fell to 42% in patients undergoing septal/turbinate surgery who also had nasal allergy. Presence of nasal allergy was the only independent predictor of treatment failure. Patients with nasal valve surgery reported significantly greater symptomatic improvement following surgery. The newly formed NASION scale demonstrated internal consistency with a Cronbach α of 0.9 and excellent change-responsiveness and convergent validity with correlation coefficients of 0.64 and 0.77 against treatment-related changes in SNOT-22 and NOSE scales, respectively.
  
  
  CONCLUSIONS
  Successful surgical outcomes can be achieved with the use of a structured history, clinical evaluation and physiological testing. Flow-volume loops can help elucidate the cause of nasal obstruction. The newly formed NASION scale is a validated retrospective single time-point patient outcome measure.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.
authors.forename: S A R
authors.initials: SA
authors.lastname: Nouraei
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.|Anglia Ruskin University, Chelmsford, Essex, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Virk
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.
authors.forename: H
authors.initials: H
authors.lastname: Kanona
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Zatonski
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.
authors.forename: E F
authors.initials: EF
authors.lastname: Koury
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK.|Anglia Ruskin University, Chelmsford, Essex, UK.
authors.forename: P
authors.initials: P
authors.lastname: Chatrath
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015508:Nasal Obstruction / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012882:Skin Tests