Assessment of subjective scales for selection of patients for nasal septal surgery

Objective: To investigate the use of subjective measures to assist the surgeon in patient selection for septal surgery. Study design: Prospective, observational. Approved by local ethics committee. Setting: ENT outpatient department, University Hospital of Wales. Participants: Forty-six participants on the waiting list for septal surgery for nasal obstruction. Main outcome measure: Measurement of nasal partitioning of airflow by rhinospirometer (GM Instruments, Scotland), subjective scales, and investigator's assessment of septal deviation. Results: The subjective scores, and investigator's assessment of septal deviation, were compared with the rhinospirometer objective measurements for correlation, sensitivity and specificity. The rhinospirometry results showed that 20% of the patients on the waiting list had objective measures of partitioning of nasal airflow within a normal range for healthy subjects. The ordinal scale proved to be more useful than the visual analogue scale for patient selection. The subjective scores of airflow partitioning from the double ordinal scale correlated well with the rhinospirometry measurements (r = 0.8). The ordinal scale also had a sensitivity of 81% and a specificity of 60%. The investigator's subjective assessment of septal deviation had a high sensitivity at around 100% but had a lower specificity (30%). Conclusions: The use of a subjective ordinal scale to measure partitioning of airflow greatly increased the specificity of patient selection and it is proposed that this scale may be useful to the surgeon when assessing patients for septal surgery