Cottle classification in the diagnosis of nazal septum deviation; determination of validity, internal consistency and diagnostic value

Objective and Hypothesis In our study, the distribution of peak nasal inspiratory flow (PNIF) and nasal obstruction symptom evaluation (NOSE) values was determined in normal individuals and the definition of pathological values was made accordingly. The validity of the nasal septum deviation (NSD) classification criteria defined in the literature, its relationship with the symptom, and its relationship with the objective measurement performed with PNIF were evaluated, and its internal consistency was tested by expert evaluation of nasal endoscopic images. Thus, it was aimed to determine the diagnostic cut-off point of nasal septum deviation. Materials and Methods The classifications in the literature, which were reached by searching with Medical subject headings (MESH) keywords '' NOSE, Septum, Surgery, Outcome '' among the articles up to September 2017 in the Pubmed database, were evaluated. Cottle classification was chosen because of the intensive use and simplicity of the classification itself and the like. Between February 2020 and September 2020, 140 people who applied to Dokuz Eylül University Department of Otorhinolaryngology Clinic with non-nasal complaints were included in the study to determine the PNIF and NOSE norms. Sixty-one people who applied with the complaint of nasal obstruction and were diagnosed with NSD were evaluated with the NOSE questionnaire and PNIF, and their results were compared with normal values. Nasal endoscopic video recordings were evaluated by specialist physicians according to the Cottle classification. Results The NOSE scale can be used to distinguish those with and without nasal obstruction. The '5.5' value was found as the cutoff point, with sensitivity and specificity of 90.2% and 89.3% respectively. According to the measurements made in the normal data group, PNIF global value is higher in men and has a positive weak correlation with height, it does not correlate with age. PNIF global averages of the nasal septal deviation (NSD) group do not differ from the normal group, but due to the difference between groups, PNIF global normative value should be calculated for each patient according to age, height, and gender. NOSE and PNIF global value show a weak negative correlation in the NSD group. According to the Cottle classification, there are 44 patients in the NSD group of 61 patients with a consensus rate of 60% and above. The average of PNIF global values of the consensus groups is not different from the rest of the group. However, in the 60%, 70%, 80% and 90% consensus groups, the deviation side PNIF value is lower than the non-deviated side and those with no consensus. Conclusion The NOSE scale is useful in distinguishing people with and without nasal obstruction. If NOSE is six and above, nasal obstruction should be considered, but it is not a marker alone. Consensus among evaluators for the Cottle classification is low, and in groups with high consensus, the NOSE and PNIF values are not different from the rest of the group. PNIF measurement in the NSD group is lower on the deviated side compared to the non-deviated side and normal. PNIF measurement can be used in the diagnosis of NSD and should also be measured unilaterally. Personalized assessment is required in the diagnosis of NSD. Key words Symptom Assessment, Nazal Obstruction, Nasal Septum, Reference Values, Peak Nasal Inspiratory Flow