Title: Diagnosis of Chronic Rhinosinusitis – CT Paranasal Sinus and Diagnostic Nasal Endoscopy: A Comparative Study
Authors: Peri Sreekavya, G.Raghunadha Babu, P.S.R.Rajeswari, Kalyani Hanumanthu
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.41
Abstract
Rhinitis and Sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now Rhinosinusitis. Most guidelines and expert panel documents now have adoptedthe term Rhinosinusitis instead of sinusitis. It is an inflammatory condition affecting thelining of the sinuses and nasal passages that can be variablein its clinical presentation. Proper diagnosis and classification of this disorder are important for effective management.
The Diagnosis of Chronic Rhinosinusitis based on various diagnostic modalities like CT PNS and Diagnostic Nasal endoscopy and their efficacy of precise diagnosis was evaluated. The accuracy was determined to assess the role of nasal endoscopy. Patients with age morethan 12 presenting for the assessment of chronicrhinosinusitis, not responding to medical treatment for more than 12 weeks, suffering from at least two or more of the symptoms like nasal obstruction, anterior or posteriornasal discharge, abnormalities of smell, and headache or facial pains were prospectively analyzed. All the selected patients were subjected to nasal endoscopy, followed by CTPNS. The Endoscopic findings were scored according to the Lund Kennedy scoring system. The CT PNS scans were scored according to the Lund Mackay scoring system.
The clinical diagnosis of CRS was determined based on the published sinusitis guideline criteria for adults, and the nasal endoscopic findings were compared with the diagnostic gold standard CT scan. A total of 100 patients were studied in this prospective hospital-based study.
Endoscopy was able to diagnose 84 % as CRS based on Lund–Kennedy score ≥ 2. 91 % patients could be labelled as CRS based on Lund–Mackey scores ≥ 4. On correlating the nasal endoscopy and CT PNS, it was found that sensitivity was 84.61 %, specificity was 22.22 %, PPV was 91.66 %, NPV was 12.5 %. The positive likelihood ratio of 1.08 and a negative likelihood ratio of 0.69 was found, and the p-value was found to be 0.1345, which confirms thatthere is no significant difference in diagnosing CRS by either modality. The addition of nasal endoscopy helps to reduce the use of CT, lowering costs, and radiation exposure.
Keywords: Chronic rhinosinusitis (CRS), Diagnostic nasal endoscopy (DNE), Computed tomography of paranal sinuses (CT PNS).
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