Objective versus Subjective Outcomes Assessment in Rhinology

Abstract

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, similar findings 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.