The Arabic nasal obstruction symptom evaluation scale (Arabic NOSE): validation and severity categorization in Middle Eastern population

OBJECTIVE: The aim of this study was to adapt the NOSE instrument into the Arabic language using a cohort that reflects the linguistic and cultural diversity of Middle Eastern nationalities and dialects. Additionally, the study aimed to evaluate score distribution and propose a preliminary severity categorization using a Middle Eastern cohort. METHODS: The NOSE scale was translated into Arabic using a forward-backward translation process. Adult native Arabic speakers (≥ 16 years) were recruited from Otolaryngology and Facial Plastic Surgery clinics. Participants included patients with nasal obstruction and asymptomatic controls with normal endoscopic examinations. Construct validity was assessed by correlations with patient-reported visual analog scale (VAS) scores (0-10 scale, where 0 indicates no obstruction and 10 indicates maximal obstruction). Internal consistency, test-retest reliability, responsiveness to surgical intervention, and score discrimination between groups were evaluated. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff score. RESULTS: A total of 235 participants completed the Arabic NOSE scale, including 182 patients with nasal obstruction and 53 normal controls. The Arabic NOSE score was significantly higher in patients with nasal obstruction than in controls (62.9 ± 22.2 vs. 7.8 ± 7.6; p < 0.001). The scale demonstrated excellent internal consistency (Cronbach's α = 0.92) and strong test-retest reliability (r = 0.93). Arabic NOSE scores correlated strongly with patient-reported VAS severity (r = 0.90) and surgeon-assessed severity (r = 0.83). ROC analysis identified a cutoff score of < 25 as optimal for distinguishing normal from symptomatic participants (sensitivity 96.2%, specificity 94.3%). Among surgical patients, mean NOSE scores improved significantly from 66.9 preoperatively to 10.9 postoperatively (mean change 56.0; p < 0.001), demonstrating high responsiveness. The effect size for pre- to post-operative change was large (Cohen's d = 2.5). CONCLUSIONS: The Arabic NOSE scale demonstrated excellent reliability, validity, and responsiveness for assessing nasal obstruction in Arabic-speaking populations. A cutoff score of < 25 demonstrated excellent discrimination between asymptomatic individuals and patients with nasal obstruction within this cohort. The proposed severity classification and ROC-derived threshold are preliminary and require prospective external validation in independent Arabic-speaking populations before widespread clinical adoption.