What Is the NOSE Scale?

Back to Blog

If you’ve come in for an airway evaluation at our office, you may have been handed a short five-question form before your appointment. It’s called the NOSE scale — and while it looks simple, it’s one of the most useful tools we have for understanding how much your nasal breathing is actually affecting your life.

What does NOSE stand for?

NOSE stands for Nasal Obstruction Symptom Evaluation. It was developed and validated by researchers in 2004 and has since become the gold-standard patient-reported outcome measure used by ENTs, sleep physicians, and airway-focused clinicians worldwide to assess the severity of nasal obstruction.

It’s not a diagnostic test — it doesn’t tell us what’s causing your nasal obstruction. What it does is give us a reliable, standardized snapshot of how much that obstruction is bothering you, in your own words.

The five questions

The NOSE scale asks you to rate five symptoms based on how much they’ve affected you over the past month, on a scale from 0 (not a problem) to 4 (severe problem):

• Nasal congestion or stuffiness — Do you feel congested or stuffy, even without a cold?
• Nasal blockage or obstruction — Does it feel like something is physically blocking your nose?
• Trouble breathing through your nose — Is nasal breathing itself labored or difficult?
• Trouble sleeping — Does your nasal obstruction affect your ability to fall or stay asleep?
• Trouble getting enough air during exercise — Do you find yourself gasping or mouth breathing when you exercise?

How is it scored?

You add up your five responses (maximum raw score of 20), then multiply by five to get a final score out of 100. The higher the score, the more severely nasal obstruction is affecting your quality of life.

Why do we use it?

There are two main reasons we ask patients to fill out the NOSE scale at Dental Solutions of South Florida.

First, it helps us understand your starting point. Nasal obstruction is subjective — two patients with the same physical anatomy can experience it very differently. One person with a mildly narrowed nasal passage might barely notice it; another finds it ruins their sleep and limits their exercise. The NOSE scale captures that lived experience in a way that a scan or physical exam alone cannot.

Second, it helps us measure whether what we’re doing is actually working. Research tells us that a change of 15 to 20 points on the NOSE scale represents a clinically meaningful improvement — something the patient genuinely feels in their daily life. By having you complete the scale before and after treatment, we can track real progress rather than relying on subjective impressions alone.

What treatments might follow?

Depending on your NOSE score and the findings from your evaluation, we may discuss one or more of the following approaches:

• Nasal Release Therapy (NRT) — a gentle in-office technique that physically widens the nasal passage to improve airflow
• Tonsil laser decontamination — a CO2 laser treatment to reduce swollen tonsil tissue contributing to airway crowding
• Tongue tie evaluation — if tongue posture is contributing to nasal obstruction and mouth breathing
• Epigenetic arch expansion — for patients who want a longer-term structural improvement in airway space

Not every patient needs all of these. The NOSE scale is simply where the conversation starts — giving us a shared, objective language for something that can otherwise be hard to describe.