From the Department of Otolaryngology, Boston University School of Medicine.
Plast Reconstr Surg. 2020 Aug;146(2):277-280. doi: 10.1097/PRS.0000000000006978.
Despite the widespread use of the Cottle maneuver as a finding to define nasal valve collapse, no studies have confirmed the association between a positive Cottle maneuver and need for nasal valve repair. This study demonstrates the low construct validity of the Cottle maneuver.
One hundred healthy volunteer students and employees at Boston Medical Center were recruited for this study. Participants were asked to evaluate their breathing on a 10-point scale, rating their subjective airflow in each nostril while occluding the contralateral nostril, where 0 indicated complete obstruction and 10 indicated complete patency. Following the baseline ratings, participants were asked to rate their breathing once again while examiners preformed the Cottle and modified Cottle maneuvers.
Overall, 97 percent of participants reported improved airflow in each nostril following the Cottle maneuver (p < 0.00001); 98 percent reported improved airflow in each nostril following the modified Cottle maneuver (p < 0.00001).
If the clinical consensus regarding the observed improvement in nasal airflow is to be followed, nearly all the participants recruited are experiencing some surgically correctable nasal obstruction. Given the population from which our cohort was collected-students and residents from a medical campus-such a conclusion seems extremely unlikely. We believe the more likely explanation for the high positive test rate is flawed assumptions of the Cottle and modified Cottle maneuvers.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
尽管 Cottle 手法被广泛用于发现鼻阀塌陷，但尚无研究证实阳性 Cottle 手法与鼻阀修复需求之间的关联。本研究表明 Cottle 手法的构建效度较低。
本研究招募了 100 名波士顿医疗中心的健康志愿者学生和员工。参与者被要求在 10 分制上评估他们的呼吸状况，在阻塞对侧鼻孔的情况下，对每个鼻孔的主观气流进行评分，其中 0 表示完全阻塞，10 表示完全通畅。在基线评分后，检查者进行 Cottle 手法和改良 Cottle 手法，参与者再次对呼吸进行评分。
总体而言，97%的参与者报告 Cottle 手法后每个鼻孔的气流改善（p<0.00001）；98%的参与者报告改良 Cottle 手法后每个鼻孔的气流改善（p<0.00001）。
如果要遵循临床共识，即观察到的鼻气流改善，那么几乎所有被招募的参与者都经历了一些可通过手术纠正的鼻阻塞。鉴于我们的研究对象是来自医学园区的学生和居民，这种结论似乎极不可能。我们认为，阳性测试率较高的更可能的解释是 Cottle 手法和改良 Cottle 手法的假设存在缺陷。
临床问题/证据水平：治疗性，V。
