Validation of the Visual Analog Scale in Perennial Allergic and Non-Allergic Rhinitis: Association With Symptom...

Although the visual analog scale (VAS) is recommended in guidelines for assessing perennial allergic rhinitis (PAR), its validity in non-allergic rhinitis (NAR) remains unclear.

To evaluate the concurrent validity of the VAS in assessing symptom severity and its association with quality of life (QoL) outcomes in PAR and NAR.

This cross-sectional study prospectively included adults with moderate to severe PAR and NAR, all of whom had experienced symptoms for more than 6 months and underwent skin prick and/or specific IgE testing. Individual nasal symptoms, total nasal symptom score (TNSS), VAS, and Rhinoconjunctivitis Quality of Life-36 (RCQ-36) scores were compared between groups. We assessed VAS validity via Spearman's correlation with TNSS. Participants were dichotomized at the median VAS to examine associations with RCQ-36 and symptom profiles.

Among 445 patients (298 PAR and 147 NAR), TNSS was lower in NAR, but VAS global scores and RCQ-36 domains were similar, except for a trend toward higher eye symptom burden in PAR. The VAS correlated moderately with TNSS in PAR (Spearman correlation = 0.49, 95% CI, 0.40-0.57) but weakly in NAR (Spearman correlation = 0.35; 95% CI, 0.20-0.49). Patients with a VAS result of 70 mm or greater (median cutoff) had significantly worse RCQ-36 in both groups, along with higher VAS for eye itching, postnasal drip, nasal voice, facial pressure, hyposmia, and cough. Greater nasal obstruction and rhinorrhea severity strongly correlated with poorer QoL.

The VAS demonstrates comparable validity in PAR and NAR, effectively categorizing disease severity and QoL impairment. Nasal congestion and rhinorrhea severity are key drivers of reduced QoL in both conditions.