Clin Exp Otorhinolaryngol.  2024 Aug;17(3):234-240. 10.21053/ceo.2024.00099.

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective

• Kim SJ
• Bang JH
• Lee KH

• KMID: 2558840
• DOI: http://doi.org/10.21053/ceo.2024.00099

Abstract

Objectives
. Nasal valve surgery for internal nasal valve (INV) compromise has become increasingly popular. However, this rise in popularity has sparked debates regarding its indications and disputes over insurance coverage, primarily due to the lack of a gold-standard evaluation method. Therefore, we aimed to identify objective parameters for the INV compromise.
Methods
. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data comprised facial computed tomography (CT) images, acoustic rhinometry, the modified Cottle test, and symptom scores. Patients were categorized based on their symptoms and the results of the modified Cottle test. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using CT.
Results
. The compromised INV group, characterized by nasal obstruction with a positive modified Cottle test, exhibited smaller INV areas in both coronal and axial views, reduced INV volume in the axial view, and a thinner lateral wall in the coronal view (all P<0.05). Acoustic rhinometry indicated a smaller minimal cross-sectional area and volume in the compromised INV group (both P<0.001). Regression analysis demonstrated significant associations between a compromised INV and reduced INV area on the axial view, as well as the minimal cross-sectional area measured by acoustic rhinometry.
Conclusion
. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Alternatively, the INV area on axial CT scans and the minimal cross-sectional area measured by acoustic rhinometry may serve as objective parameters for evaluating INV compromise.

Keyword

Nasal Obstruction; Nasal Valve; Nasal Valve Compromise; Nasal Surgical Procedures; Computed Tomography; Acoustic Rhinometry

Figure

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  Fig. 1. Selected sections of facial computed tomography scans for internal nasal valve measurements. (A) Coronal view. (B) Axial view. The red dotted line indicates the midline.

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  Fig. 2. Measurement parameters in selected computed tomography scans. (A) Internal nasal valve (INV) angle with the outer vertex on a coronal view. (B) INV angle with the outer vertex on an axial view. (C) INV angle with the inner vertex on a coronal view. (D) INV angle with the inner vertex on an axial view. (E) INV area on a coronal view. (F) INV area on an axial view. (G) Lateral wall thickness on a coronal view. (H) Lateral wall thickness on an axial view. (I) Septal angle on a coronal view. (J) Septal angle on an axial view. (K, L) Nasal bone area on a reconstructed three-dimensional lateral view.

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  Fig. 3. Area under the curve (AUC) values for the significant predictors identified in the regression analysis, along with their combination, to predict internal nasal valve (INV) compromise based on the receiver operating characteristic curve. Age adjusted. MCA, minimal cross-sectional area; CT, computed tomography.

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