Neutral endopeptidase activity and concentration of sensory neuropeptide in the human nasal mucosa

Human nasal mucosa biopsy samples were studied by biochemical and histological methods to determine whether the concentration of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) as a marker of sensory nerves was dependent on the activity of neutral endopeptidase-like enzyme (NEP-LE). Mucosal samples from the middle turbinate were obtained from 32 patients undergoing functional endoscopic nasal surgery for non-allergic chronic rhinosinusitis. The degree of symptoms related to nasal obstruction, rhinorrhea and headaches was recorded. The number of inflammatory cells in each biopsy sample was evaluated by conventional histopathological examination. CGRP-LI was measured by radioimmunoassay. The activity of NEP-LE was evaluated in vitro using [3H] Leu5-enkephalin as substrate. A good correlation was observed between increased concentrations of CGRP, abundant inflammatory cells and the intensity of symptoms (R2 = 0.80). A low activity of NEP-LE was associated with a high concentration of both inflammatory cells and CGRP, suggesting that NEP-LE activity was reduced during inflammation. These observations further support the hypothesis that reduced degradation of sensory neuropeptides could be involved in the pathophysiological mechanisms of non-specific chronic rhinosinusitis.     

Objective versus subjective outcomes assessment in rhinology

BACKGROUND: Prior studies on the relationship between computed tomography scan findings and patient-based quality of life in chronic rhinosinusitis (CRS) have found very low correlations. Whereas surprising, similarfindings have been noted in other diseases. METHODS: We performed a cross-sectional analysis of the association between objective and subjective findings in nasal septal deformity and a systematic review and synthesis of the literature on CRS and other diseases. RESULTS: We found no association between objective anatomic findings and subjective symptoms in nasal obstruction (R = 0.03; Kruskal-Wallis test, p = 0.97). Multiple studies in CRS and other diseases-sleep apnea, hearing loss, asthma, etc.- have found similarly low correlations between objective and subjective testing. CONCLUSION: For nasal septal deviation and CRS, the patient's subjective perception of disease severity has, at best, a very weak association with objective assessment of severity. Patient-based outcomes assessment remains important; these instruments apparently quantify an aspect of disease not detected by objective testing.     

Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively

PurposeEmpty nose syndrome (ENS) is characterized by nasal dryness, crusting, and paradoxical nasal obstruction most commonly after inferior turbinate resection. ENS has also been reported to occur after middle turbinate resection (MTR), and concern for causing ENS is a possible reason surgeons preserve the MT during endoscopic sinus surgery (ESS). The objective was to determine whether MTR during ESS led to ENS.Materials and methodsThis was a prospective case series of 95 consecutive patients that underwent bilateral subtotal MTR during ESS with either Draf IIB or Draf III frontal sinusotomies, for chronic rhinosinusitis with or without nasal polyps, and frontal sinus inverted papillomas. Demographic data and postoperative Empty Nose Syndrome 6-item Questionnaire (ENS6Q) scores were obtained. Nasal crusting was also documented on last postoperative nasal endoscopy.ResultsPathologies included chronic rhinosinusitis with nasal polyps (69), without nasal polyps (12), and inverted papillomas (14). Fifty-six patients underwent subtotal MTRs during ESS with Draf IIB, and 39 with Draf III. Mean follow-up was 19.4 months (range 12–49). Mean postoperative ENS6Q score was 2.1. Only 2.1% had ENS6Q scores ≥ 11, and 6.3% had nasal crusting at last follow-up. None of the patients with ENS6Q scores ≥ 11 had nasal crusting at last follow-up. There were no significant differences in outcomes between ages, genders, surgery types, or pathologies.ConclusionsPatients who underwent bilateral subtotal MTR during ESS were unlikely to develop ENS by at least 1 year postoperatively, based on patients rarely experiencing ENS6Q scores ≥ 11 or persistent nasal crusting.     

Platelet-rich plasma injection for empty nose syndrome: A case report

Empty nose syndrome (ENS) is a relatively rare disease found in patients who have undergone sinonasal surgery, characterized by excessive reduction of the turbinate, causing intranasal turbulence and loss of receptors within the nasal mucosa. Patients diagnosed with the disease usually experience symptoms including dryness of the nose, nasal pain, paradoxical nasal obstruction, and crusts in the nasal cavity. ENS can be treated with conservative care such as nasal irrigation or nasal moisturizers. Accurate efficacy of surgical treatment of ENS is often difficult to predict and is accompanied by operational obstacles and complications. Platelet-rich plasma (PRP) has recently gained attention as a regenerative therapy in several medical fields. We present two cases of ENS treated by injection of PRP as a simple and less invasive method, and describe its efficacy with nasal endoscopy and subjective questionnaires.     

症状、CT和鼻声反射在慢性鼻窦炎组织重构诊断中的意义

目的探讨鼻塞症状、CT扫描Lund-Mackay评分和鼻声反射测量鼻黏膜充血指数与慢性鼻及鼻窦炎(chronic rhinosinusitis,CRS)组织重构程度之间的相关性,探讨三者在CRS组织重构诊断中的意义。方法选取CRS患者43例,应用视觉模拟评分(visual analogous scale,VAS)系统评价鼻塞症状;Lund- Mackay平分系统评价鼻窦CT扫描结果;鼻声反射测量获取鼻黏膜充血指数;钩突黏膜组织标本行鼻黏膜纤维化程度评分。应用统计学方法对其相关性进行分析。结果鼻塞症状严重程度与鼻黏膜纤维化程度之间无明显相关性(r=-0.046,P=0.77);CT评分与黏膜组织纤维化评分之间无相关性(r=0.132,P=0.40);鼻黏膜纤维化程度与鼻黏膜充血指数之间呈负相关(r=-0.348, P=0.022)。结论鼻黏膜充血指数能够反映病变黏膜的组织重构程度,辅助症状与CT检查指导CRS治疗策略。     

Biofilm detection in chronic rhinosinusitis by combined application of hematoxylin-eosin and gram staining

The pathomechanism of chronic rhinosinusitis with nasal polyposis (CRS/NP) seems to be unclear. Bacterial-, fungal- and combined biofilms might play a potential role in the pathogenesis of various inflammatory diseases and recently in CRS/NP. A prospective, blinded observational study was performed to confirm that the combination of conventional hematoxylin–eosin (HE) and Gram staining protocols could be used to detect bacterial and fungal biofilms in patients with CRS/NP. A total of 50 patients with CRS/NP undergoing endoscopic sinus surgery (ESS) were analyzed. The negative control group consisted of 12 patients undergoing septoplasty for nasal obstruction without CRS/NP. The nasal polyps and inferior turbinate mucosa specimens applied as negative controls were processed to HE and Gram staining. Biofilm was detected in 44 of 50 patients with CRS/NP and in none of 12 negative controls. In our series, HE method showed an obvious correlation with the results of Gram staining and was allocated to be a good predictor of biofilm existence. It was found that the microscopic structure and thickness of biofilms were strongly associated with the integrity of nasal mucosa and with the characteristics of subepithelial cellular infiltration. This study confirmed the presence of bacterial and fungal biofilms on the surface of NPs obtained from patients with CRS. Since biofilms may affect the severity and recurrence rate of CRS treated by ESS they should be detected histologically. In conclusion, HE staining combined with Gram protocol is a robust and reliable method for the detection of bacterial and fungal biofilms in CRS/NP.     

中性粒细胞和嗜酸性粒细胞在慢性鼻窦炎中的相互影响及临床治疗思考

慢性鼻窦炎(CRS)按其病理特征分为嗜酸性粒细胞(EOS)型和非嗜酸性粒细胞(nEOS)型,其中nEOS型中最常见的是中性粒细胞(neutrophil, NEU)浸润。EOS主导Th2型炎症,NEU浸润更多见于Th1和Th17型炎症。长期以来,认为NEU和EOS在CRS发病机制中可能处于相互排斥的对立关系。但近年研究发现,在临床症状最重的难治性CRS鼻黏膜或鼻息肉组织中,NEU和EOS浸润均明显增多,并且相互影响。通过文献复习,对CRS中NEU和EOS混合性炎症及两者之间相互影响的研究进展进行综述,并就临床治疗对策进行讨论。     

Epithelial genes in chronic rhinosinusitis with and without nasal polyps

BACKGROUND: Genetic studies on chronic inflammatory diseases have resulted in an emphasis on the epithelial interface with the environment and the genes that influence this interaction. This study examines the expression of key epithelial genes implicated in the pathogenesis of other inflammatory disorders for their role in chronic rhinosinusitis (CRS). METHODS: Epithelial cells were collected from the inferior turbinate, middle turbinate, and/or uncinate from 62 subjects undergoing sinonasal surgery. Patient groups included 21 CRS patients with nasal polyposis, 23 CRS patients without nasal polyposis, and 18 controls. Samples were analyzed for S100A7, S100A8, S100A9, SLC9A3R1, G-protein-coupled receptor for asthma, and serine protease inhibitor kazal type 5 (SPINK5) by quantitative real-time polymerase chain reaction. Immunohistochemistry (IHC) was performed to analyze expression of SPINK5 lympho epithelial kazal-type inhibitor (LEKTI) in sinonasal samples. RESULTS: Expression of S100A7 and S100A8 was significantly decreased in CRS with and without nasal polyps when compared with controls. S100A9 expression was significantly decreased in CRS without nasal polyps, and SPINK5 expression was significantly decreased in CRS with nasal polyps. SPINK5 (LEKTI) protein was detected in sinonasal tissue and was significantly decreased in polyp samples using IHC. CONCLUSION: This study shows marked reductions in the level of expression of several genes involved in epithelial barrier maintenance and repair in the inflammatory state of CRS.     

Surgical treatment for empty nose syndrome

OBJECTIVES: To detail empty nose syndrome (ENS), an iatrogenic disorder characterized by a patent airway but a subjective sense of poor nasal breathing, and to explore repair options for patients with ENS. DESIGN: A case series of 8 patients with ENS detailing symptoms before and after submucosal implantation of acellular dermis. SETTING: Academic medical center. PATIENTS: Subjects who were evaluated for abnormal nasal breathing and determined to have ENS. Patients were diagnosed as having ENS if they described characteristic symptoms, had evidence of prior nasal turbinate surgery, and their symptoms improved after they underwent a cotton test. INTERVENTION: Acellular dermis was implanted submucosally to simulate missing turbinate tissue. MAIN OUTCOME MEASURES: Symptoms and symptom scores for the 20-item Sino-Nasal Outcome Test completed before and after the implantation were gathered. RESULTS: A statistically significant improvement in symptom scores for the Sino-Nasal Outcome Test was noted (P < or = .02). CONCLUSIONS: Careful assessment allows reconstructive surgery through submucosal implantation of acellular dermis. Symptoms of patients with ENS can improve with surgical therapy.     

Changes of nasal function after temperature-controlled radiofrequency tissue volume reduction for the turbinate

OBJECTIVES: Temperature-controlled and temperature-monitored radiofrequency tissue volume reduction (RFTVR) for the turbinate is a new treatment modality for nasal obstruction secondary to turbinate hypertrophy. We compared the nasal functions after the treatment ofRFTVR and laser vaporizing turbinoplasty (LVT) using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: Twenty-four patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively evaluated from March 1999 to October 1999 at Seoul National University Hospital (Seoul, Korea). Sixteen patients were treated with RFTVR, and eight patients with LVT. The preoperative and postoperative nasal functions were investigated by visual analogue scale of symptoms, butanol threshold test, saccharine test, acoustic rhinometry, rhinomanometry, and ciliary beat frequency. RESULTS: At 8 weeks postoperatively, the severity and the frequency of nasal obstruction improved subjectively in 81.3% and 93.8% of RFTVR group and in 87.5% and 87.5% of LVT group, respectively. Significant improvement of nasal symptoms began from 2 to 3 days after the operation in the RFTVR group, whereas there was significant improvement of nasal symptoms at 8 weeks after operation in the LVT group. However, objective nasal functions including nasal volume and total nasal resistance were significantly improved at 8 weeks after surgery in both groups. Among patients reporting symptoms of hyposmia, 55.6% of RFTVR group and 63.6% of LVT group showed improved olfaction. Saccharin transit time and ciliary beat frequency were preserved after RFTVR CONCLUSION: RFTVR for the turbinate may be useful as an alternative approach for the treatment of chronic turbinate hypertrophy.     

改良鼻窦CT嗅区评分对慢性鼻-鼻窦炎鼻息肉嗅觉评估及预后判断的价值

目的　探讨改良鼻窦CT嗅区评分对慢性鼻-鼻窦炎鼻息肉患者术前嗅觉功能评估及术后嗅觉功能判断的价值。方法　前瞻性分析慢性鼻-鼻窦炎鼻息肉患者54例,排除合并哮喘、变应性鼻炎和伴有可能影响嗅觉功能的系统性因素。所有患者均接受功能性鼻内镜手术和规范的药物治疗,并行术后随访。根据鼻窦CT冠状位嗅裂区堵塞程度评为0、1、2分,分别对嗅裂前区（anterior olfactory cleft score,AOCS）（中鼻甲对应嗅裂区）和嗅裂后区（posterior olfactory cleft score,POCS）（上鼻甲对应嗅裂区）进行评分。术前所有患者均进行T&T嗅觉检测、嗅觉VAS评分和改良鼻窦CT嗅区评分和鼻窦CT Lund-Mackay评分,术后行T&T嗅觉检测、嗅觉VAS评分。分别将患者术前及术后6个月嗅觉阈值、嗅觉VAS评分与改良鼻窦CT嗅区评分和Lund-Mackay评分进行线性回归分析。结果　本研究纳入慢性鼻-鼻窦炎鼻息肉患者54例,其中男性36例,女性18例,平均年龄47.9岁（24～67岁）,其中30例患者随访达到6个月。线性回归分析结果显示,患者T&T嗅觉阈值与嗅觉VAS评分有显著相关性（Pearson相关系数r =0.70,P <0.01）。手 术前改良鼻窦CT嗅区评分AOCS和POCS均与嗅觉阈值评分、嗅觉VAS评分显著正相关（P <0.001）,Lund-Mackay评分与嗅觉阈值也有弱相关性（R 2=0.262,P =0.005）。手术前鼻窦CT嗅区评分AOCS、POCS与术后6个月的嗅觉阈值亦有相关性（R 2=0.211、0.181,P =0.014、0.024）,且术前AOCS与术后6个月嗅觉阈值正相关性更强。术前Lund-Mackay评分与术后6个月嗅觉阈值无相关性（R 2=0.073,P =0.165）。结论　改良鼻窦CT嗅区评分可作为慢性鼻-鼻窦炎鼻息肉患者术前嗅觉功能和功能性鼻内镜手术后嗅觉功能预后的客观评价指标。中鼻甲对应的嗅裂区的病变程度对嗅觉功能评价作用更重要。     

鼻腔结构重塑在慢性鼻-鼻窦炎治疗前后的主客观评估及相关性研究

目的探讨慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者行鼻腔结构重塑前后的主客观评估及相关性研究。方法对70例CRS患者鼻内镜下行下鼻甲射频消融外移术、中鼻甲成形术及窦口鼻道复合体功能性切除术,同期行鼻中隔黏膜下矫正术。术前对所有患者作主观症状视觉模拟量表(visual analog scale,VAS)调查、客观检查及评分、Lund-Kennedy内镜评分和Lund-Mackay CT评分。术后随访1年,分别行以上3种评分,并作相关性分析。结果术前VAS评分总分与CT评分呈显著正相关(r=0.39,P<0.01),内镜评分与CT评分呈正相关(r=2.11,P<0.05),但嗅觉障碍的VAS评分与内镜、CT评分无相关性,差异无统计学意义。术前VAS与术后VAS评分差异具有统计学意义(t=39.51,P<0.01),术后VAS与术后内镜评分差异具有统计学意义(r=0.59,P<0.01),术前与术后Lund-Kennedy内镜评分比较差异具有统计学意义(t=39.30,P<0.01)。结论术前VAS评分、CT评分、内镜评分呈正相关,术后随访1年,手术后主观症状VAS总分与术前差异具有统计学意义,与术后Lund-Kennedy内镜评分呈正相关。术前及术后的鼻塞、头晕、面部疼痛、鼻漏症状与客观评估有相关性。手术需多方面评价,有利于个体化的手术。     

Acoustic rhinometry in persons recruited from the general population and diagnosed with chronic rhinosinusitis according to EPOS

Chronic rhinosinusitis (CRS) is a disease related to the nose and the paranasal sinus as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. The criteria include subjective symptoms, such as nasal obstruction, and objective findings by endoscopy. Acoustic rhinometry (AR) is an objective method to determine nasal cavity geometry. The technique is based on a sound pulse reflection analysis in the nasal cavity and determines cross-sectional areas as a function of distance as well as volume. AR measurements in persons recruited from the general population, with and without CRS based on the clinical EPOS criteria, were investigated. As part of a trans-European study, 362 persons, comprising 91 persons with CRS and 271 persons without CRS, were examined by an otolaryngologist including rhinoscopy. Minimum cross-sectional area, distance to minimum cross-sectional area, and volume in the nasal cavity were measured by acoustic rhinometry and all participants underwent Peak Nasal Inspiratory Flow (PNIF) and allergy test. A difference in AR was found before and after decongestion, but no difference was seen between CRS patients and controls. Positive correlation between AR and PNIF was found and AR was capable of identifying mucosal oedema and septum deviation visualised by rhinoscopy. In conclusion, AR, as a single instrument, was not capable of discriminating persons with CRS from persons without CRS in the general population. However, AR correlates well with PNIF and was capable of identifying septum deviation and mucosal oedema.     

鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响

目的探讨鼻腔扩容术对伴有鼻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的主客观症状的影响,为鼻腔扩容术对鼻塞伴OSAHS的患者治疗提供有效的临床依据。方法选择69例伴有鼻塞的OSAHS患者,针对病变的鼻中隔、下鼻甲、中鼻甲、钩突、筛泡等不同部位的病变进行个体化的处理。根据呼吸暂停低通气指数(AHI)及最低动脉血氧饱和度(LSaO2)分为三组:轻度、中度与重度组。通过比较患者手术前后多导睡眠检测(PSG)结果及鼻塞视觉模拟评分量表(VAS)、Epworth嗜睡量表(ESS)、患者鼾声问卷(SS)评分,分析鼻腔扩容术对鼻塞伴OSAHS患者的主客观症状的影响。结果术后6个月随访显示,其中轻度OSAHS患者的AHI、LSaO2及平均动脉氧饱和度(MSaO2)有所升高(P<0.05),VAS、ESS及SS评分都有所降低(P<0.05)。中度OSAHS患者的PSG相关检测指标均无明显变化(P>0.05),VAS、ESS及SS评分有所降低(P均<0.05)。重度患者除VAS及ESS评分有所降低(P<0.05),PSG相关客观指标及SS评分均无明显变化(P>O.05)。结论鼻腔扩容手术可以改善鼻塞为主的OSAHS患者的鼻塞、睡眠打鼾及白天嗜睡等主观症状,对轻度OSAHS患者的疗效优于中重度OSAHS。对鼻塞伴OSAHS患者的治疗有重要的临床意义。     

Parameters of nasal airway anatomy on magnetic resonance imaging correlate poorly with subjective symptoms of nasal patency.

Forty-four patients undergoing magnetic resonance imaging (MRI) head scans for non-nasal disease were asked to complete a questionnaire immediately after the scan. Subjective patency was scored for each nasal airway, patients were also asked about other nasal symptoms, hay fever, upper respiratory tract infections, medication and any history of nasal surgery or trauma. The following measurements from MRI scans were made: the cross-sectional area of the nasal airway at the anterior end of the middle turbinate, the horizontal width of the inferior turbinate and maximum septal mucosal thickness. In addition the presence of any septal deviation and the thickness or the mucosa of the paranasal sinuses was assessed. Correlation between subjective airway patency and the anatomical parameters studied was generally very weak. However, patients with sinus mucosal thickening on MRI scanning had significantly lower subjective patency scores (left P = 0.003, right P = 0.029) for both nasal airways. Assessment of the nasal airway on MRI correlates poorly with symptoms of nasal obstruction. However, patients with sinus mucosal thickening (> 5 mm) had significantly more symptoms of nasal obstruction on both sides.     

儿童慢性鼻窦炎的外科治疗研究进展

近年来,儿童慢性鼻窦炎(CRS)越来越受到耳鼻咽喉科医生的重视。临床上,有一部分儿童CRS患者经过规范的药物治疗(不少于12周)后症状仍难以改善,甚至加重,或是经常复发,导致治疗失败。大量的临床实践表明,儿童鼻窦FESS手术可以取得比较满意的临床疗效,但仍有医师对儿童鼻窦FESS手术治疗存在质疑。鼻窦球囊扩张术治疗慢性鼻窦炎于2005年被引入耳鼻咽喉科。在过去的十几年里,有充分的证据支持它在治疗成人慢性鼻窦炎(CRS)方面的安全性和有效性。鼻窦球囊扩张术手术过程中不去除骨质,保留大部分或全部鼻窦黏膜,以极低的风险恢复鼻窦的通气,这样微创的方式适用于儿童。本文将对儿童慢性鼻窦炎外科治疗的相关研究进展做一综述。     

Chronic rhinosinusitis and endoscopic sinus surgery

Olfactory dysfunction is a major symptom reported by patients with chronic rhinosinusitis (CRS). Surgical treatment of this disease requires close surveillance of such dysfunction because of wide ranging implications for safety, quality of life, and impact on the flavor of foods and beverages. This review highlights key findings regarding the influences of endoscopic sinus surgery (ESS) on olfactory function across the unique presentations of CRS. Such findings provide information useful for informing patients of potential complications and for obtaining informed consent prior to surgical intervention. ESS has been shown to improve olfaction across all types of CRS as assessed through quantitative testing and subjective reports. The presence of nasal polyposis (NP) and eosinophilia have been identified as predictors of significant postoperative olfactory improvement. When indicated, judicious partial resection of the middle turbinate may result in improved olfactory function without a risk of long term complication. Careful attention to the olfactory cleft and frontal sinus recess are important in limiting olfactory complications by avoiding indiscriminate disruption of olfactory epithelium. Given the chronic nature of the disease, surveillance of olfactory function in patients with CRS is a lifelong activity that will evolve as emerging technologies become available.     

Correlation of nasal obstruction with nasal cross-sectional area measured by computed tomography in patients with nasal septal deviation

Objectives: The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum. Methods: Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS). Results: Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation. Conclusions: This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.     

Parameters of nasal airway anatomy on magnetic resonance imaging correlate poorly with subjective symptoms of nasal patency

Forty-four patients undergoing magnetic resonance imaging (MRI) head scans for non-nasal disease were asked to complete a questionnaire immediately after the scan. Subjective patency was scored for each nasal airway, patients were also asked about other nasal symptoms, hay fever, upper respiratory tract infections, medication and any history of nasal surgery or trauma. The following measurements from MRI scans were made: the cross-sectional area of the nasal airway at the anterior end of the middle turbinate, the horizontal width of the inferior turbinate and maximum septal mucosal thickness. In addition the presence of any septal deviation and the thickness or the mucosa of the paranasal sinuses was assessed. Correlation between subjective airway patency and the anatomical parameters studied was generally very weak. However, patients with sinus mucosal thickening on MRI scanning had significantly lower subjective patency scores (left P= 0.003, right P= 0.029) for both nasal airways. Assessment of the nasal airway on MRI correlates poorly with symptoms of nasal obstruction. However, patients with sinus mucosal thickening ( > 5 mm) had significantly more symptoms of nasal obstruction on both sides.