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CPAP Clarity

NOSE Scale for Nasal Blockage

Five questions ear, nose and throat specialists use to measure how much a blocked nose bothers you. Useful before a mask conversation if you use CPAP.

Over the past 1 month, how much of a problem were the following conditions for you?

0 / 5

1.Nasal congestion or stuffiness
2.Nasal blockage or obstruction
3.Trouble breathing through my nose
4.Trouble sleeping
5.Unable to get enough air through my nose during exercise or exertion

Answer all 5 questions (5 left).

What This Tool Does

The Nasal Obstruction Symptom Evaluation (NOSE) scale asks how much five nose-related problems have bothered you over the past month, from a stuffy nose to running short of air during exercise. It turns your answers into a score from 0 to 100 and places it in the severity classes published for the scale. It measures how much the symptoms bother you, not what causes them.

Who Made It

Michael Stewart and colleagues developed the NOSE scale at four US academic medical centers and published it in Otolaryngology, Head and Neck Surgery in 2004. They tested it with adults who had a deviated nasal septum and reported adequate test-retest reliability (0.702) and internal consistency (0.785). The work was funded by the American Academy of Otolaryngology, Head and Neck Surgery Foundation, which offers the scale at no cost and asks only that users reference the study. We do, under every result.

In 2013, Lipan and Most at Stanford looked at the scores of 345 patients and proposed the severity classes shown with your result. A score of 30 best separated patients with and without nasal obstruction in their data.

Reading Your Score

  • A score of 0 means no symptoms were reported.
  • 5 to 25 is the mild class.
  • 30 to 50 is the moderate class.
  • 55 to 75 is the severe class.
  • 80 to 100 is the extreme class.

Scores only move in steps of 5, because each answer point is multiplied by 5. Retaking the scale after a change, such as allergy season ending or a new treatment, shows whether symptoms moved.

A Blocked Nose and CPAP

Nasal masks and nasal pillows depend on air moving freely through the nose. When the nose is blocked, some people end up breathing through the mouth, which can mean leaks and a dry mouth. A NOSE score gives you and your provider a number to talk about instead of a vague complaint. Mask style, humidity and the cause of the blockage are all worth discussing with your doctor or an ENT. The mask finder quiz asks about congestion too.

Frequently Asked Questions

How is the NOSE scale scored?

Each of the five questions scores 0 (not a problem) to 4 (severe problem). The five answers are added, giving 0 to 20, and the sum is multiplied by 5 for a final score from 0 to 100. Higher means worse nasal symptoms.

What NOSE score counts as nasal obstruction?

A 2013 study by Lipan and Most proposed classes of mild (5 to 25), moderate (30 to 50), severe (55 to 75) and extreme (80 to 100). In their data a score of 30 best separated people with and without nasal obstruction. The classes describe how much the symptoms bother you; they do not say what is causing them.

Why does nasal blockage matter if I use CPAP?

Nasal masks and nasal pillows send air in through the nose, so a blocked nose can make them harder to use and can lead to breathing through the mouth. Mask style and humidity are both things people review with their provider when the nose is the problem.

Who should I talk to about a high NOSE score?

Your doctor first, and they may refer you to an ENT (an ear, nose and throat specialist), who can look for causes such as a deviated septum, allergies or swollen tissue inside the nose. If you use CPAP, also mention it to whoever fitted your mask.

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