Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria

Merma-Linares, C., Martinez, M.D., Gonzalez, M. et al. Curr Allergy Asthma Rep (2023). https://doi.org/10.1007/s11882-023-01104-y

Abstract

Purpose of Review

Objective criteria score of mechanical nasal obstruction (0–6). 
a Nasal septum score (0–2): 0 = “no septum deformity”;
1 = “non obstructive septum deformity”;
2 = “obstructive septum deformity”. 
b Inferior turbinate score (0–4):0 = “no inferior turbinate enlargement”;
1 = “non obstructive turbinate enlargement;
2 = “obstructive turbinate enlargement

Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient’s quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP).

Recent Findings

A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP).

Summary

Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.

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