Rhee John S, Sullivan Corbin D, Frank Dennis O, Kimbell Julia S, Garcia Guilherme J M
JAMA Facial Plast Surg. 2014 May-Jun;16(3):219-25; quiz 232. doi: 10.1001/jamafacial.2013.2473.
IMPORTANCE A gold standard objective measure of nasal airway obstruction (NAO) does not currently exist, so patient-reported measures are commonly used, particularly the Nasal Obstruction Symptom Evaluation (NOSE) scale and the visual analog scale (VAS). However, questions remain regarding how best to use these instruments. OBJECTIVES To systematically review studies on NOSE and VAS scores in patients with NAO and to compile and standardize the data to (1) define symptomatic and normative values for presurgical and postsurgical patients with NAO, asymptomatic individuals, and the general population; (2) determine if postsurgical scores are comparable with asymptomatic scores; and (3) determine if there is a clinically useful preoperative and postoperative score change. EVIDENCE REVIEW A systematic review of the literature was performed through PubMed for studies assessing NOSE and VAS scores in patients with chronic NAO. Strict inclusion criteria were applied to focus on anatomic obstruction only. For statistical analysis, the patients were classified as asymptomatic, presurgical and postsurgical with NAO, and the general population. FINDINGS The mean (SD) NOSE and VAS scores for a patient with NAO were 65 (22) and 6.9 (2.3), respectively. The mean postsurgical NOSE and VAS scores were 23 (20) and 2.1 (2.2), respectively. The mean asymptomatic individual NOSE and VAS scores were 15 (17) and 2.1 (1.6). The mean NOSE and VAS scores for the general population were 42 (27) and 4.6 (2.6), respectively. The mean presurgical to postsurgical change was more than 40 for NOSE scores and more than 4.0 for VAS scores. CONCLUSIONS AND RELEVANCE We have shown that normative and abnormal value ranges for NOSE and VAS can be established for clinical use. Given the consistency of both scales, we conclude that these measures can be used as a clinically meaningful measure of successful surgical outcomes.
重要性 目前尚无用于评估鼻气道阻塞（NAO）的金标准客观测量方法，因此通常采用患者自我报告的测量方法，尤其是鼻阻塞症状评估（NOSE）量表和视觉模拟量表（VAS）。然而，关于如何最佳使用这些工具仍存在问题。目的 系统评价有关NAO患者的NOSE和VAS评分的研究，并汇总和标准化数据，以（1）确定NAO手术前后患者、无症状个体及普通人群的症状性和正常参考值；（2）确定术后评分是否与无症状评分具有可比性；（3）确定术前和术后评分变化在临床上是否具有实用价值。证据评价 通过PubMed对评估慢性NAO患者的NOSE和VAS评分的研究进行系统评价。应用严格的纳入标准，仅关注解剖学阻塞情况。进行统计分析时，将患者分为无症状、NAO手术前和手术后以及普通人群。结果 NAO患者的平均（标准差）NOSE和VAS评分分别为65（22）和6.9（2.3）。术后NOSE和VAS的平均评分分别为23（20）和2.1（2.2）。无症状个体的平均NOSE和VAS评分分别为15（17）和2.1（1.6）。普通人群的平均NOSE和VAS评分分别为42（27）和4.6（2.6）。NOSE评分从术前到术后的平均变化超过40，VAS评分超过4.0。结论与意义 我们已经证明，可以建立NOSE和VAS的正常参考值范围及异常值范围以供临床使用。鉴于这两种量表的一致性，我们得出结论，这些测量方法可作为手术成功结果的有临床意义的指标。
