Nasal Symptom Burden and Psychological Distress in Adults with Nasal Obstruction

Objective: Nasal obstruction is a common rhinologic complaint that may impair sleep quality, daily functioning, and quality of life. Although psychological distress has been reported in rhinologic disorders, its relationship with patient-reported symptom burden in adults with obstruction primarily related to septal deviation and inferior turbinate hypertrophy remains unclear. Methods: This cross-sectional study included 114 adults presenting with nasal obstruction between January and April 2026. Patients with chronic rhinosinusitis, nasal polyposis, rhinitis, acute sinonasal infection, previous nasal surgery, obesity, known sleep disorders, or diagnosed psychiatric disease were excluded. Septal deviation and inferior turbinate hypertrophy were clinically assessed. Nasal symptom burden was evaluated using the Nasal Obstruction Symptom Evaluation scale and Sino-Nasal Outcome Test-22, whereas psychological distress was assessed using the Hospital Anxiety and Depression Scale. Correlation, multivariable logistic regression, and exploratory receiver operating characteristic (ROC) analyses were performed. Results: Patients with anxiety and depressive symptoms had significantly higher Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test-22 scores. Both scores showed moderate-to-strong positive correlations with Hospital Anxiety and Depression Scale anxiety and depression scores. In adjusted analyses, both symptom scores remained independently associated with anxiety and depressive symptom categories, whereas anatomical grading variables were not significantly associated with psychological outcomes. Receiver operating characteristic analyses showed moderate discriminatory performance, with Sino-Nasal Outcome Test-22 showing slightly stronger discrimination for anxiety symptoms. Conclusion: Greater patient-reported nasal symptom burden was associated with higher anxiety and depressive symptom levels in adults with obstruction primarily related to septal deviation and inferior turbinate hypertrophy. These findings are associative, not causal, and should not be generalized to inflammatory sinonasal diseases.