Assessment of nasal obstruction: Correlation between subjective and objective techniques

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Mustafayev, E. Civelek, F. Orhan, H. Yüksel, A.B. Boz, B.E. Şekerel" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Mustafayev" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Civelek" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Orhan" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Yüksel" ] 4 => array:2 [ "nombre" => "A.B." "apellidos" => "Boz" ] 5 => array:2 [ "nombre" => "B.E." 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"apellidos" => "Valero" "email" => array:1 [ 0 => "valero@clinic.ub.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Grupo de Alergología Clínica y Experimental (GACE), Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Alergia, Servicio de Neumología y Alergia Respiratoria, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Investigación Biomédica en red para Enfermedades Respiratorias (CIBERES), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Alergia, Fundación Valle del Lili, Cali, Colombia" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unitat de Rinologia i Clinica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionThe nasal airways humidify, filter, and warm the air we breathe. Consequently, they account for 50% of resistance in the respiratory tract.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Nasal obstruction is our perception of air passing through the nasal airways. It has been defined as discomfort caused by insufficient airflow in the nose or as the sensation of increased resistance of airflow through the nostrils. The sensation of airflow through the nose arises from the cooling of the sensory receptors in the nostrils during inspiration. These receptors are innervated by the trigeminal nerve, and anaesthesia or damage of this nerve can produce a sensation of nasal obstruction.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Nasal obstruction is one of the main symptoms of the various conditions affecting the nose and may be due to anatomical abnormalities, inflammatory processes (eg. rhinitis), nasal polyps, and tumours.Objective assessment of nasal obstruction involves direct examination of the area or volume of the nasal cavity or indirect analysis of nasal airflow and resistance.Subjective assessment of nasal symptoms using symptom scores (including those examining nasal obstruction) are highly variable; therefore, the visual analogue scale [VAS] has been proposed as a tool to evaluate severity<a class="elsevierStyleCrossRef" href="#bib0015">3</a>. The most widely-used objective methods to assess nasal obstruction are active anterior rhinomanometry, acoustic rhinometry, and measurement of peak nasal inspiratory airflow (PNIF).<a class="elsevierStyleCrossRef" href="#bib0015">3</a>A recent review evaluated recommendations on the use of these approaches and the correlations between them.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Few studies have examined the correlation between subjective and objective methods for assessing nasal obstruction.<a class="elsevierStyleCrossRefs" href="#bib0020">4,6</a>We analysed the correlation between subjective and objective techniques used to evaluate nasal obstruction.Materials and methodsDesignWe performed a prospective descriptive study based on the voluntary participation of 184 clinicians attending an educational course on rhinitis during the period 2002–2008. Nasal obstruction was subjectively assessed using a symptom score (0, absence of symptoms or mild symptoms; 1, moderate symptoms; and 2, severe symptoms) and a VAS scoring from 0 to 10cm (0 indicated absence of symptoms and 10 indicated more severe symptoms). Nasal obstruction was also objectively assessed using active anterior rhinomanometry to record airflow (RMN Q) and resistance (RMN R) during inspiration and expiration in both nostrils (Rhinospir PRO, Sibel, Barcelona, Spain), acoustic rhinometry (SER 2000, RhinoMetrics, Lynge, Denmark) to determine the minimal cross-sectional area (MCSA) and nasal volume (0–6cm and 0–12cm [V0–6 and V0–12]) from both nostrils, and measurement of PNIF in L/min (Clement Clark International, Essex, UK) by recording the highest result of three manoeuvres. Throughout the study, the same trained physicians assessed nasal obstruction using these subjective and objective approaches.Statistical analysisQualitative variables were analysed using proportions. Quantitative variables were analysed using measures of position, central tendency, and dispersion. Values were compared using the Mann–Whitney test. The Spearman correlation coefficient (rho) was calculated. A 95% confidence level was set with a 5% alpha error. Statistical significance was set at p<0.05. Correlations were generally considered weak if r≤0.4, moderate if 0.4<r<0.8, and strong if r>0.8.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>ResultsMean (SD) age was 37.1 (6.9) years with a range of 25–56 years. Women accounted for 61% of the sample. The values for the symptom score, VAS, active anterior rhinomanometry, acoustic rhinometry, and PNIF are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The correlations between the subjective and objective methods are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(a)Correlation between subjective methods<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010">Symptom score and VAS were moderately correlated.</li></ul></li><li class="elsevierStyleListItem" id="lsti0015">(b)Correlation between objective methods<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020">Correlation between rhinomanometry variables</li></ul>The values for RMN Q and RMN R correlated strongly in both inspiration and expiration.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0025">Correlation between acoustic rhinometry variables</li></ul>The values for V0–6 and V0–12 were moderately correlated; V0–6 and MSCA were weakly correlated.<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0030">Correlation between anterior rhinomanometry and acoustic rhinometry</li></ul>MCSA correlated moderately with anterior RNM R in inspiration and weakly with RMN Q and RMN R. MCSA correlated weakly with all the anterior rhinomanometry values.<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0035">Correlation between acoustic rhinometry variables and PNIF variables</li></ul>MSCA and PNIF were moderately correlated.</li><li class="elsevierStyleListItem" id="lsti0040">(c)Correlation between subjective and objective methods<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0045">Correlation between acoustic rhinometry and symptom score</li></ul>Symptom score correlated weakly with acoustic rhinometry (V0–6 and MCSA).</li></ul><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Analysis of the correlations between patients with greater or less nasal obstruction, depending on whether they had rhinitis at the time of the evaluation or whether they had a symptom score of 0–1 vs. 2–3 or a VAS score of <4 vs. >4, revealed no differences with respect to data obtained from an analysis of the total sample (data not shown).DiscussionWe applied different subjective and objective techniques to assess nasal obstruction. The correlations between these techniques were generally weak or moderate. The most notable results were the strong correlation between the different parameters for active anterior rhinomanometry (r>0.8) and moderate correlation (0.4<r<0.8) between the symptom score and VAS and between MCSA and RMN R and PNIF.VAS and several symptom scores have been shown to reveal changes in the severity of perceived nasal obstruction<a class="elsevierStyleCrossRef" href="#bib0025">5</a> and a certain degree of correlation.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> We found correlations to be moderate; therefore, we suggest that both methods are similar when applied for subjective assessment of nasal obstruction.Opinions on the value of objective assessment of nasal obstruction are divergent.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> PNIF has been used in several studies and its sensitivity is comparable to that of acoustic rhinometry and active anterior rhinomanometry.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> We found a moderate correlation with MCSA and a weak correlation with active anterior rhinomanometry.Acoustic rhinometry has been compared with active anterior rhinomanometry. Its properties enable it to measure changes that are not assessed using active anterior rhinomanometry. Furthermore, several authors have found differences between the techniques and suggested that they should complement each other.<a class="elsevierStyleCrossRefs" href="#bib0055">11–13</a> Our weak correlations between the different variables in each technique, despite being moderate between MCSA and resistance, reinforce the concept that these techniques assess different aspects of nasal obstruction and are therefore complementary.Correlations between subjective and objective measurements have also been investigated. In a study involving 250 volunteers, Jones et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> did not find an association between the subjective sensation of nasal obstruction and active anterior rhinomanometry. Gungor et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> did not find correlations between VAS and acoustic rhinometry during the nasal cycle. In other studies, the subjective nature of nasal obstruction correlates better with measurements of airflow resistance (RMN) than with acoustic rhinometry.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> A strong correlation has also been observed between PNIF and the subjective sensation of nasal obstruction.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Despite the differences between subjective and objective techniques, all the methods provide reliable results and are used in several studies to evaluate the effect of treatment. Available data enable us to say that nasal obstruction should be evaluated using at least one subjective technique and one objective technique; PNIF should be reserved for outpatient monitoring of nasal obstruction.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Although André et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> suggest that the presence of nasal obstruction could improve correlations between active anterior rhinomanometry and acoustic rhinometry, we did not find differences (data not shown) in the correlations depending on the degree of nasal obstruction. Consequently, correlations do not vary in patients who perceive greater nasal obstruction according to the symptom score, VAS, or presentation of symptoms of rhinitis at the time of the examination.In conclusion, nasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assess different aspects of nasal obstruction making them complementary.Ethical disclosuresPatients’ data protectionConfidentiality of data. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentRight to privacy and informed consent. The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.Protection of human subjects and animals in researchProtection of human and animal subjects. The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.Conflict of interestThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres296092" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Materials and methods" 4 => "Results" 5 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec279766" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Patients’ data protection" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human subjects and animals in research" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack69194" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-19" "fechaAceptado" => "2012-05-17" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec279766" "palabras" => array:6 [ 0 => "Nasal obstruction" 1 => "Anterior rhinomanometry" 2 => "Acoustic rhinometry" 3 => "Peak nasal" 4 => "Inspiratory flow" 5 => "Visual analogue scale" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundNasal sensation of airflow describes the perception of the passage of air through the nose. Nasal obstruction can be assessed using subjective techniques (symptom scores and visual analogue scales [VAS]) and objective techniques (anterior rhinomanometry [RMN], acoustic rhinometry [AR], and peak nasal inspiratory flow [PNIF]). Few studies have evaluated the correlation between these techniques. ObjectiveThe primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction. Materials and methodsNasal obstruction was assessed using a symptom score, VAS, RMN, AR (minimal cross-sectional area [MCSA] and volume), and PNIF in 184 volunteer physicians. Spearman's rho was recorded. Correlations were considered weak if r≤0.4, moderate if 0.4<r<0.8, and strong if r>0.8. ResultsMean (SD) age was 37.1 (6.9) years (range, 25–56 years); 61% were women. We found a strong correlation (r>0.8; p=0.001) between the different parameters of RMN and a moderate correlation between symptom score and VAS (r=0.686; p=0.001) and between MCSA and RMN (resistance) (r=0.496; p=0.001) and PNIF (r=0.459; p=0.001). The correlations were weak or non-significant for the remaining comparisons. ConclusionNasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assesses different aspects of nasal obstruction, thus making them complementary." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "VAS, visual analogue scale; V0–6, volume between 0 and 6cm; V0–12, volume between 0 and 12cm; MCSA, minimal cross-sectional area; RMN, anterior rhinomanometry; Q, airflow; R, resistance; PNIF, peak nasal inspiratory flow.Pa/L/s, pascal/litre/second; L/min, litre/minute." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptom score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visual analogue scale, cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.3 (0–3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acoustic rhinometry, V0–6 cm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.2 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.4 (11.6–16.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acoustic rhinometry, V0–12 cm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.4 (19.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.2 (43.6–66.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acoustic rhinometry, MCSA cm2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.8 (0.6–0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN Q, inspiration (L/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">604.9 (252.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">569 (438–762) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN R, inspiration (Pa/L/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (0.2–0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN Q, expiration (L/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">608.5 (255.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">568 (445.5–724) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN R, expiration (Pa/L/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 (0.2–0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PNIF (L/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122.7 (39.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (93.8–150) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431797.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Subjective and objective variables in the assessment of nasal obstruction." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "V0–6, volume between 0 and 6 cm; V0–12, volume between 0 and 12 cm; MCSA, minimal cross-sectional area; RMN, anterior rhinomanometry; Q, airflow; R, resistance; VAS, visual analogue scale; PNIF, peak nasal inspiratory flow." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Symptom score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">V0–6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">V0–12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">MCSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RMN Q, inspiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RMN R, inspiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RMN Q, expiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">RMN R, expiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">VAS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PNIF \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptom score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.237<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.265<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.184 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.205 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.686<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.152 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V0−6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.237<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.658<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.248<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.064 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.088 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.083 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">V0−12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.658<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.136 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.057 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.143 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.061 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.133 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.065 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MCSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.265<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.248<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.136 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.300<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.496<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.257<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.322<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.459<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN Q, inspiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.057 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.300<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.966<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.918<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.863<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.089 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.257<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN R, inspiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.184 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.064 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.143 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.490<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.966<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.907<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.861<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.365<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN Q, expiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.205 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.061 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.257<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.918<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.907<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−.893<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.090 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.188<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RMN R, expiration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.088 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.133 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n 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valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.041 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.293<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.686<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " 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Original article

J.J. Yepes-Nuñeza, J. Bartrab,c,d, R. Muñoz-Canob,c,d, J. Sánchez-Lópezb, C. Serranoe, J. Mullolc,d,f, I. Alobidc,d,f, J. Sastrec,g, C. Picadob,c,d, A. Valerob,c,d,

Corresponding author

valero@clinic.ub.es

Corresponding author.

a Grupo de Alergología Clínica y Experimental (GACE), Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia, Medellín, Colombia

b Unidad de Alergia, Servicio de Neumología y Alergia Respiratoria, Hospital Clínic, Barcelona, Spain

c Centro de Investigación Biomédica en red para Enfermedades Respiratorias (CIBERES), Spain

d Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

e Unidad de Alergia, Fundación Valle del Lili, Cali, Colombia

f Unitat de Rinologia i Clinica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic, Barcelona, Spain

g Servicio de Alergia, Fundación Jiménez Díaz, Madrid, Spain

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inflammatory processes &#40;eg&#46; rhinitis&#41;&#44; nasal polyps&#44; and tumours&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Objective assessment of nasal obstruction involves direct examination of the area or volume of the nasal cavity or indirect analysis of nasal airflow and resistance&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Subjective assessment of nasal symptoms using symptom scores &#40;including those examining nasal obstruction&#41; are highly variable&#59; therefore&#44; the visual analogue scale &#91;VAS&#93; has been proposed as a tool to evaluate severity<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; The most widely-used objective methods to assess nasal obstruction are active anterior rhinomanometry&#44; acoustic rhinometry&#44; and measurement of peak nasal inspiratory airflow &#40;PNIF&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">A recent review evaluated recommendations on the use of these approaches and the correlations between them&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Few studies have examined the correlation between subjective and objective methods for assessing nasal obstruction&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We analysed the correlation between subjective and objective techniques used to evaluate nasal obstruction&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Design</span><p id="par0035" class="elsevierStylePara elsevierViewall">We performed a prospective descriptive study based on the voluntary participation of 184 clinicians attending an educational course on rhinitis during the period 2002&#8211;2008&#46; Nasal obstruction was subjectively assessed using a symptom score &#40;0&#44; absence of symptoms or mild symptoms&#59; 1&#44; moderate symptoms&#59; and 2&#44; severe symptoms&#41; and a VAS scoring from 0 to 10<span class="elsevierStyleHsp" style=""></span>cm &#40;0 indicated absence of symptoms and 10 indicated more severe symptoms&#41;&#46; Nasal obstruction was also objectively assessed using active anterior rhinomanometry to record airflow &#40;RMN <span class="elsevierStyleItalic">Q</span>&#41; and resistance &#40;RMN <span class="elsevierStyleItalic">R</span>&#41; during inspiration and expiration in both nostrils &#40;Rhinospir PRO&#44; Sibel&#44; Barcelona&#44; Spain&#41;&#44; acoustic rhinometry &#40;SER 2000&#44; RhinoMetrics&#44; Lynge&#44; Denmark&#41; to determine the minimal cross-sectional area &#40;MCSA&#41; and nasal volume &#40;0&#8211;6<span class="elsevierStyleHsp" style=""></span>cm and 0&#8211;12<span class="elsevierStyleHsp" style=""></span>cm &#91;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span> and <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;12</span>&#93;&#41; from both nostrils&#44; and measurement of PNIF in L&#47;min &#40;Clement Clark International&#44; Essex&#44; UK&#41; by recording the highest result of three manoeuvres&#46; Throughout the study&#44; the same trained physicians assessed nasal obstruction using these subjective and objective approaches&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Qualitative variables were analysed using proportions&#46; Quantitative variables were analysed using measures of position&#44; central tendency&#44; and dispersion&#46; Values were compared using the Mann&#8211;Whitney test&#46; The Spearman correlation coefficient &#40;rho&#41; was calculated&#46; A 95&#37; confidence level was set with a 5&#37; alpha error&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Correlations were generally considered weak if <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#44; moderate if 0&#46;4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#44; and strong if <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mean &#40;SD&#41; age was 37&#46;1 &#40;6&#46;9&#41; years with a range of 25&#8211;56 years&#46; Women accounted for 61&#37; of the sample&#46; The values for the symptom score&#44; VAS&#44; active anterior rhinomanometry&#44; acoustic rhinometry&#44; and PNIF are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The correlations between the subjective and objective methods are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Correlation between subjective methods<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><p id="par0060" class="elsevierStylePara elsevierViewall">Symptom score and VAS were moderately correlated&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Correlation between objective methods<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0020"><p id="par0070" class="elsevierStylePara elsevierViewall">Correlation between rhinomanometry variables</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">The values for RMN <span class="elsevierStyleItalic">Q</span> and RMN <span class="elsevierStyleItalic">R</span> correlated strongly in both inspiration and expiration&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0025"><p id="par0080" class="elsevierStylePara elsevierViewall">Correlation between acoustic rhinometry variables</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">The values for <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span> and <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;12</span> were moderately correlated&#59; <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span> and MSCA were weakly correlated&#46;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0030"><p id="par0090" class="elsevierStylePara elsevierViewall">Correlation between anterior rhinomanometry and acoustic rhinometry</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">MCSA correlated moderately with anterior RNM <span class="elsevierStyleItalic">R</span> in inspiration and weakly with RMN <span class="elsevierStyleItalic">Q</span> and RMN <span class="elsevierStyleItalic">R</span>&#46; MCSA correlated weakly with all the anterior rhinomanometry values&#46;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0035"><p id="par0100" class="elsevierStylePara elsevierViewall">Correlation between acoustic rhinometry variables and PNIF variables</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">MSCA and PNIF were moderately correlated&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Correlation between subjective and objective methods<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0045"><p id="par0115" class="elsevierStylePara elsevierViewall">Correlation between acoustic rhinometry and symptom score</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall">Symptom score correlated weakly with acoustic rhinometry &#40;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span> and MCSA&#41;&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Analysis of the correlations between patients with greater or less nasal obstruction&#44; depending on whether they had rhinitis at the time of the evaluation or whether they had a symptom score of 0&#8211;1 vs&#46; 2&#8211;3 or a VAS score of &#60;4 vs&#46; &#62;4&#44; revealed no differences with respect to data obtained from an analysis of the total sample &#40;data not shown&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">We applied different subjective and objective techniques to assess nasal obstruction&#46; The correlations between these techniques were generally weak or moderate&#46; The most notable results were the strong correlation between the different parameters for active anterior rhinomanometry &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41; and moderate correlation &#40;0&#46;4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#41; between the symptom score and VAS and between MCSA and RMN <span class="elsevierStyleItalic">R</span> and PNIF&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">VAS and several symptom scores have been shown to reveal changes in the severity of perceived nasal obstruction<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and a certain degree of correlation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We found correlations to be moderate&#59; therefore&#44; we suggest that both methods are similar when applied for subjective assessment of nasal obstruction&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Opinions on the value of objective assessment of nasal obstruction are divergent&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> PNIF has been used in several studies and its sensitivity is comparable to that of acoustic rhinometry and active anterior rhinomanometry&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> We found a moderate correlation with MCSA and a weak correlation with active anterior rhinomanometry&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Acoustic rhinometry has been compared with active anterior rhinomanometry&#46; Its properties enable it to measure changes that are not assessed using active anterior rhinomanometry&#46; Furthermore&#44; several authors have found differences between the techniques and suggested that they should complement each other&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a> Our weak correlations between the different variables in each technique&#44; despite being moderate between MCSA and resistance&#44; reinforce the concept that these techniques assess different aspects of nasal obstruction and are therefore complementary&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Correlations between subjective and objective measurements have also been investigated&#46; In a study involving 250 volunteers&#44; Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> did not find an association between the subjective sensation of nasal obstruction and active anterior rhinomanometry&#46; Gungor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> did not find correlations between VAS and acoustic rhinometry during the nasal cycle&#46; In other studies&#44; the subjective nature of nasal obstruction correlates better with measurements of airflow resistance &#40;RMN&#41; than with acoustic rhinometry&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> A strong correlation has also been observed between PNIF and the subjective sensation of nasal obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Despite the differences between subjective and objective techniques&#44; all the methods provide reliable results and are used in several studies to evaluate the effect of treatment&#46; Available data enable us to say that nasal obstruction should be evaluated using at least one subjective technique and one objective technique&#59; PNIF should be reserved for outpatient monitoring of nasal obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Although Andr&#233; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> suggest that the presence of nasal obstruction could improve correlations between active anterior rhinomanometry and acoustic rhinometry&#44; we did not find differences &#40;data not shown&#41; in the correlations depending on the degree of nasal obstruction&#46; Consequently&#44; correlations do not vary in patients who perceive greater nasal obstruction according to the symptom score&#44; VAS&#44; or presentation of symptoms of rhinitis at the time of the examination&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; nasal obstruction can be assessed using subjective and objective approaches&#46; The correlations between objective techniques were moderate to strong&#46; In addition&#44; between subjective techniques we reported a moderate correlation&#46; Finally&#44; the correlations between the subjective and objective techniques were weak and absent&#46; These findings suggest that each of the techniques assess different aspects of nasal obstruction making them complementary&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients&#8217; data protection</span><p id="par0170" class="elsevierStylePara elsevierViewall">Confidentiality of data&#46; The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">Right to privacy and informed consent&#46; The authors have obtained the informed consent of the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human subjects and animals in research</span><p id="par0180" class="elsevierStylePara elsevierViewall">Protection of human and animal subjects&#46; The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "titulo" => "Protection of human subjects and animals in research"
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    "fechaRecibido" => "2012-04-19"
    "fechaAceptado" => "2012-05-17"
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            0 => "Nasal obstruction"
            1 => "Anterior rhinomanometry"
            2 => "Acoustic rhinometry"
            3 => "Peak nasal"
            4 => "Inspiratory flow"
            5 => "Visual analogue scale"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nasal sensation of airflow describes the perception of the passage of air through the nose&#46; Nasal obstruction can be assessed using subjective techniques &#40;symptom scores and visual analogue scales &#91;VAS&#93;&#41; and objective techniques &#40;anterior rhinomanometry &#91;RMN&#93;&#44; acoustic rhinometry &#91;AR&#93;&#44; and peak nasal inspiratory flow &#91;PNIF&#93;&#41;&#46; Few studies have evaluated the correlation between these techniques&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nasal obstruction was assessed using a symptom score&#44; VAS&#44; RMN&#44; AR &#40;minimal cross-sectional area &#91;MCSA&#93; and volume&#41;&#44; and PNIF in 184 volunteer physicians&#46; Spearman&#39;s rho was recorded&#46; Correlations were considered weak if <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#44; moderate if 0&#46;4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#44; and strong if <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mean &#40;SD&#41; age was 37&#46;1 &#40;6&#46;9&#41; years &#40;range&#44; 25&#8211;56 years&#41;&#59; 61&#37; were women&#46; We found a strong correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;8&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; between the different parameters of RMN and a moderate correlation between symptom score and VAS &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;686&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and between MCSA and RMN &#40;resistance&#41; &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;496&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and PNIF &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;459&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The correlations were weak or non-significant for the remaining comparisons&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nasal obstruction can be assessed using subjective and objective approaches&#46; The correlations between objective techniques were moderate to strong&#46; In addition&#44; between subjective techniques we reported a moderate correlation&#46; Finally&#44; the correlations between the subjective and objective techniques were weak and absent&#46; These findings suggest that each of the techniques assesses different aspects of nasal obstruction&#44; thus making them complementary&#46;</p>"
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">VAS&#44; visual analogue scale&#59; <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span>&#44; volume between 0 and 6<span class="elsevierStyleHsp" style=""></span>cm&#59; <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;12</span>&#44; volume between 0 and 12<span class="elsevierStyleHsp" style=""></span>cm&#59; MCSA&#44; minimal cross-sectional area&#59; RMN&#44; anterior rhinomanometry&#59; <span class="elsevierStyleItalic">Q</span>&#44; airflow&#59; <span class="elsevierStyleItalic">R</span>&#44; resistance&#59; PNIF&#44; peak nasal inspiratory flow&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pa&#47;L&#47;s&#44; pascal&#47;litre&#47;second&#59; L&#47;min&#44; litre&#47;minute&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;0&#8211;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acoustic rhinometry&#44; <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;6</span> cm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;2 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;4 &#40;11&#46;6&#8211;16&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acoustic rhinometry&#44; <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">0&#8211;12</span> cm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;4 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;2 &#40;43&#46;6&#8211;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acoustic rhinometry&#44; MCSA cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8 &#40;0&#46;6&#8211;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RMN <span class="elsevierStyleItalic">Q</span>&#44; inspiration &#40;L&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">604&#46;9 &#40;252&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">569 &#40;438&#8211;762&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RMN <span class="elsevierStyleItalic">R</span>&#44; inspiration &#40;Pa&#47;L&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;3 &#40;0&#46;2&#8211;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RMN <span class="elsevierStyleItalic">Q</span>&#44; expiration &#40;L&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">608&#46;5 &#40;255&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">568 &#40;445&#46;5&#8211;724&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RMN <span class="elsevierStyleItalic">R</span>&#44; expiration &#40;Pa&#47;L&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;3 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;3 &#40;0&#46;2&#8211;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNIF &#40;L&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122&#46;7 &#40;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;93&#46;8&#8211;150&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Symptom score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">RMN <span class="elsevierStyleItalic">Q</span>&#44; inspiration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">RMN <span class="elsevierStyleItalic">R</span>&#44; inspiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">RMN <span class="elsevierStyleItalic">Q</span>&#44; expiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">RMN <span class="elsevierStyleItalic">R</span>&#44; expiration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2012.05.010

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	1	8
2024 October	62	26	88
2024 September	44	9	53
2024 August	65	4	69
2024 July	70	7	77
2024 June	48	2	50
2024 May	73	9	82
2024 April	67	9	76
2024 March	120	8	128
2024 February	113	14	127
2024 January	87	13	100
2023 December	102	15	117
2023 November	116	10	126
2023 October	135	12	147
2023 September	70	13	83
2023 August	68	6	74
2023 July	95	13	108
2023 June	100	12	112
2023 May	110	11	121
2023 April	71	11	82
2023 March	63	7	70
2023 February	67	13	80
2023 January	71	25	96
2022 December	53	12	65
2022 November	34	15	49
2022 October	46	21	67
2022 September	41	12	53
2022 August	42	9	51
2022 July	37	10	47
2022 June	26	8	34
2022 May	39	15	54
2022 April	50	17	67
2022 March	70	19	89
2022 February	62	10	72
2022 January	339	31	370
2021 December	90	15	105
2021 November	52	19	71
2021 October	67	13	80
2021 September	29	16	45
2021 August	30	12	42
2021 July	24	14	38
2021 June	18	11	29
2021 May	24	14	38
2021 April	50	15	65
2021 March	86	12	98
2021 February	17	17	34
2021 January	6	10	16
2020 December	1	0	1
2020 November	0	4	4
2020 September	0	18	18
2020 July	0	3	3
2020 May	0	1	1
2020 April	0	1	1
2020 March	0	1	1
2020 February	0	2	2
2020 January	0	1	1
2019 December	0	3	3
2019 November	0	2	2
2019 October	0	3	3
2019 July	0	4	4
2019 June	0	2	2
2018 March	0	1	1
2018 February	10	1	11
2018 January	11	2	13
2017 December	5	4	9
2017 November	5	2	7
2017 October	19	7	26
2017 September	6	7	13
2017 August	12	8	20
2017 July	14	3	17
2017 June	11	19	30
2017 May	23	12	35
2017 April	27	14	41
2017 March	15	32	47
2017 February	8	2	10
2017 January	10	4	14
2016 December	15	6	21
2016 November	25	7	32
2016 October	26	10	36
2016 September	23	8	31
2016 August	16	6	22
2016 July	7	2	9
2016 June	24	8	32
2016 May	9	18	27
2016 April	17	18	35
2016 March	14	18	32
2016 February	13	14	27
2016 January	9	19	28
2015 December	19	8	27
2015 November	14	6	20
2015 October	13	7	20
2015 September	26	2	28
2015 August	7	11	18
2015 July	6	6	12
2015 June	5	7	12
2015 May	4	6	10
2015 April	6	5	11
2015 March	7	3	10
2015 February	21	3	24
2015 January	20	5	25
2014 December	35	10	45
2014 November	16	4	20
2014 October	2	1	3
2014 September	1	4	5
2014 August	0	1	1
2014 July	0	3	3
2014 June	2	1	3
2014 May	1	1	2
2014 April	5	4	9
2014 March	60	13	73
2014 February	37	14	51
2014 January	28	11	39
2013 December	27	9	36

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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