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

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. 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. 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. 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. 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.