The possible effect of forceful eye closure and eye opening on nasal valve cross-sectional area during endoscopy.

BACKGROUND: Nasal endoscopy is a routine procedure in the otolaryngology clinic, yet intra-procedural discomfort is common and may deter future examinations. Preliminary observations suggest that eye closure may affect the nasal valve cross-sectional area, which, in turn, has the potential to impact discomfort during endoscopy, as it is the narrowest part of the nasal passageway. OBJECTIVE: To evaluate the effect of forceful eye opening and closure on the nasal valve’s cross-sectional area using rigid video-endoscopy and digital image analysis. METHODS: A prospective pilot case series study. Nasal video endoscopy of the right nasal vestibule was performed by a rigid endoscope in 3 facial positions: relaxed, eyes tightly closed, and eyes wide open. Nasal valve images were assessed by two independent, blinded examiners, who quantified the nasal valve cross-sectional area. The area size in the “relaxed” position was used as a reference against which the area sizes in other facial positions were normalized. RESULTS: The study included 36 volunteers, of which 27 were females (75%). The mean age was 40.7 ± 12.7 years. The nasal valve cross-sectional area was significantly smaller at the “eyes tightly closed” position, compared with the “relaxed” position (Z = -5.232, p-value < 0.001) and with the “eyes wide open” position (Z = -5.169, p-value < 0.001). No significant difference was found between the “relaxed” and “eyes wide open” positions. CONCLUSION: This hypothesis-generating pilot study demonstrated that tight eye closure is associated with a significant decrease in the cross-sectional area of the nasal valve. Considering the possible relation between a narrow passage and discomfort, further studies investigating the association between eye closure and patients’ discomfort during endoscopy are encouraged.