Methods
A series of 79 consecutive Caucasian patients undergoing rhinoplasty was
studied. Nasal airway was evaluated before surgery in each patient of
this group as part of the preoperative assessment.
This series consisted of 53 women and 26 men, with ages between 17 and
68 years old (mean 36.2 y/o). Sixty-five were primary cases and 14 were
revision rhinoplasty cases. All the primary rhinoplasty cases were
looking for an aesthetic improvement of the nose, with 29 also seeking a
functional improvement of the nasal airway. For the 14 patients
undergoing revision rhinoplasty, there were several different aesthetic
indications for the revision surgery, with no functional complaints in
none of the patients in this subgroup.
In each patient the NOSE score (Nasal Obstruction Symptom Evaluation)
(24) was obtained and peak nasal inspiratory flow (PNIF) (25) was
measured before undergoing surgery. The NOSE score was chosen as
patient-reported assessment of nasal obstruction symptoms as it is a
standardized and validated disease-specific quality of life instrument
for measuring nasal obstruction (24). A version validated for the
Portuguese language (26) was used in this study. The PNIF was obtained
in each patient according to the standard rules for measuring PNIF (25).
PNIF was chosen as objective measurement of the nasal airflow as its
results not only measure nasal airflow but also correlate with nasal
resistance (27). Furthermore, this method, together with rhinomanometry,
has been found to strongly reflect both presence and severity of nasal
airway obstruction (28).
Three groups of patients were created according to the symptoms of nasal
obstruction reported by the patients: patients with NOSE score equal to
or less than 35 (N=24), patients with NOSE score between 36 and 64
(N=26) and patients with a NOSE score equal to or higher than 65 (N=29).
Three other groups of patients were created according to the level of
nasal airflow: patients with PNIF equal to or less than 70 l/min (N=20),
patients with PNIF between 71 l/Min and 109 l/min (N=39) and patients
with PNIF equal to or higher than 110 l/min (N=20).
Statistical analysis was made for the total population of this study and
for each of the groups created based on NOSE score and on PNIF value.
Mean and standard deviations (SD) were obtained for the PNIF and NOSE
scores. A multivariable linear regression model was performed in order
to investigate the association between the NOSE scores and the PNIF
values after adjusting for age and gender of the individuals. The
estimated correlation coefficient was obtained for the PNIF score and
NOSE value to check the strength of the association between these
measurements. The nonparametric Spearman’s rank correlation coefficient
was employed. A significance level of α = 0.05 was used throughout the
analysis. The statistical analysis was performed using the R statistical
software (29), employing the RStudio environment (30). The graphs were
obtained using the R package ggplot2 (31). The strength of the
correlation (r ) was valued as very week forr <0.19, week for r between 0.20 and 0.39,
moderate for r between 0.40 and 0.59, strong for r between
0.60 and 0.79 and very strong for r between 0.80 and 1 (32).