Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.
Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
JAMA Facial Plast Surg. 2016 Dec 1;18(6):449-454. doi: 10.1001/jamafacial.2016.0721.
Nasal obstruction is a common chief concern; however, a comprehensive standardized worksheet for evaluating nasal obstruction has not been developed.
To evaluate the interrater reliability between staff surgeons and otolaryngology residents using a worksheet-based standardized nasal examination and to identify specific examination findings correlated with the Nasal Obstruction Symptom Evaluation quality-of-life score.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study conducted from June to July 2012 involved 50 adults presenting to an otolaryngology clinic at a tertiary care hospital. The patients were examined by 2 board-certified facial plastic surgeons and 2 otolaryngology residents.
The inferior turbinates, septum, and internal and external nasal valve narrowing and collapse were graded bilaterally from a scale of 0 to 3 with the aid of a standardized nasal anatomy worksheet. The findings were compared between the attending staff, residents, and the entire group.
The Cohen κ coefficient for interrater reliability was calculated for each of the graded metrics. The Nasal Obstruction Symptom Evaluation scores were correlated with anatomic scores.
Of the 49 patients included in the final analysis, the mean age was 43.6 years (range, 21-82 years), and 31 were male (66.3%). Among all attending and resident examiners, a moderate to fair, statistically significant interrater reliability coefficient (P < .001) was observed in the following nasal anatomic measurements: left and right Cottle (κ = 0.582 [95% CI, 0.463-0.700] and κ = 0.580 [95% CI, 0.461-0.698], respectively), modified Cottle (κ = 0.491 [95% CI, 0.373-0.609] and κ = 0.560 [95% CI, 0.442-0.679], respectively), dynamic internal nasal valve collapse (κ = 0.204 [95% CI, 0.118-0.290] and κ = 0.232 [95% CI, 0.140-0.323], respectively), and inferior turbinate hypertrophy (κ = 0.252 [95% CI, 0.152-0.352] and κ = 0.235 [95% CI, 0.153-0.317], respectively). The trend of examination interrater reliability was similar for attending staff and the otolaryngology residents. The Nasal Obstruction Symptom Evaluation score correlated with the mean total anatomic worksheet score (Spearman ρ = 0.301; P = .048).
Interrater reliability is high in both residents and attending staff for dynamic nasal airway examinations evaluating the internal and external nasal valves and for turbinate hypertrophy assessment. The total nasal anatomic score using a standardized worksheet correlates to patient-reported nasal-specific quality of life.
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鼻塞是常见的主要关注点；然而，尚未开发出用于评估鼻塞的全面标准化工作表。
使用基于工作表的标准化鼻腔检查评估外科医生和耳鼻喉科住院医师之间的评分者间可靠性，并确定与鼻腔阻塞症状评估生活质量评分相关的特定检查结果。
设计、地点和参与者：这项横断面研究于 2012 年 6 月至 7 月在一家三级护理医院的耳鼻喉科诊所进行，涉及 50 名成年患者。由 2 名经董事会认证的面部整形外科医生和 2 名耳鼻喉科住院医师对患者进行检查。
使用标准化的鼻腔解剖工作表，从 0 到 3 分的量表对双侧下鼻甲、鼻中隔以及内、外鼻阀狭窄和塌陷进行分级。在主治医生、住院医师和整个小组之间比较了发现。
为每个分级指标计算了评分者间可靠性的 Cohen κ 系数。鼻腔阻塞症状评估评分与解剖评分相关。
在最终分析的 49 名患者中，平均年龄为 43.6 岁（范围，21-82 岁），31 名男性（66.3%）。在所有主治医生和住院医师检查者中，观察到以下鼻腔解剖测量值的中度至公平、具有统计学意义的评分者间可靠性系数（P < .001）：左侧和右侧 Cottle（κ = 0.582[95%CI，0.463-0.700]和 κ = 0.580[95%CI，0.461-0.698]）、改良 Cottle（κ = 0.491[95%CI，0.373-0.609]和 κ = 0.560[95%CI，0.442-0.679]）、动态内部鼻阀塌陷（κ = 0.204[95%CI，0.118-0.290]和 κ = 0.232[95%CI，0.140-0.323]）以及下鼻甲肥大（κ = 0.252[95%CI，0.152-0.352]和 κ = 0.235[95%CI，0.153-0.317]）。主治医生和耳鼻喉科住院医师的检查评分者间可靠性趋势相似。鼻腔阻塞症状评估评分与平均总解剖工作表评分相关（Spearman ρ = 0.301；P = .048）。
住院医师和主治医生在评估内、外鼻阀和鼻甲肥大的动态鼻腔气道检查以及评估总鼻解剖工作表方面的评分者间可靠性均较高。使用标准化工作表的总鼻腔解剖评分与患者报告的鼻腔特定生活质量相关。
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