Determining a Successful Nasal Airway Surgery: Calculation of the Patient-Centered Minimum Important Difference

Objective Determine whether the patient-identified minimum important difference (MID) in Nasal Obstruction Symptom Evaluation (NOSE) score differs from a statistically calculated estimate of MID in patients with septal deviation undergoing nasal airway surgery. Study Design Prospective cohort. Setting Tertiary academic referral center. Subjects Patients with nasal obstruction due to septal deviation. Methods Patients completed the NOSE questionnaire preoperatively and indicated the change from their baseline score that they would consider the minimum improvement required to define the septoplasty with turbinate reduction as successful. A previously published distribution-based approach was used to estimate the MID based on baseline NOSE scores. Scores were reported both as a raw score and as a percentage of patients' baseline scores. One-sample t test was used to compare the statistically estimated MID to the patient-reported MID. Results Seventy-six patients were included. The mean (SD) baseline NOSE score was 12.9 (4.03). The mean (SD) patient-identified MID was 5.3 (2.1), corresponding to a 41.1% change (95% confidence interval, 37.2-41.3) from baseline. The statistically estimated MID was 5.2 points (40.3% reduction from baseline scores). The estimated MID was not significantly different from the patient-identified MID ( P = .4). Conclusion In patients with septal deviation, an improvement of approximately 40% in their nasal obstructive symptoms as assessed by the NOSE questionnaire is required to define a nasal airway surgery as successful. The patient-identified and the statistically calculated MIDs were similar. Furthermore, this MID can be used to guide research, improving the ability to use the NOSE score as a dichotomous scoring measure (treatment success/failure) and estimating sample size.