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Conclusion: MCT is a useful tool to pre-operatively determine whether internal nasal valve (INV) narrowing affects a nasal obstruction. Functional rhinoplasty seemed to produce better results than septoplasty in Asian patients with a nasal obstruction, due to INV narrowing.Objective: This study compared pre-operative modified Cottle test (MCT) findings and post-operative clinical improvement according to surgical approach in an Asian population.Methods: One-hundred and sixty-four patients who underwent septal surgery were enrolled. The clinical symptoms, radiological findings, and paranasal computed tomography (PNS CT) scan results were compared and analyzed between the MCT-positive and -negative groups, focusing on internal nasal valve narrowing. Post-operative clinical improvement were also compared based on whether septoplasty or functional rhinoplasty was performed.Results: The MCT-positive group had significantly higher pre-operative visual analog scale scores for nasal obstruction and rhinorrhea than those in the negative group. The MCT-positive group had a significantly higher percentage of highly deviated septa on PNS CT and endoscopic findings than those in the MCT-negative group. The functional rhinoplasty group had a significantly higher MCT conversion rate (positive to negative) and improvement in nasal obstruction than those in the septoplasty group. [ABSTRACT FROM PUBLISHER]