Raherison C, Montaudon M, Stoll D, Wallaert B, Darras J, Chanez P, Crampette L, Magnan A, Demessi P, Orlando J P, Didier A, Serrano E, Prud'homme A, Meurice J C, Klossek J M, Tunon-de-Lara J M
Société de Pneumologie de Langue Française (SPLF) Working Group, CHU-Bordeaux, France.
Allergy. 2004 Aug;59(8):821-6. doi: 10.1111/j.1398-9995.2004.00487.x.
To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood.
To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination.
A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently.
Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis.
In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.
为改善哮喘控制情况，鼻窦炎的管理常使医生进行鼻窦成像和/或鼻内镜检查，但其各自的作用仍未得到充分了解。
与耳鼻喉科检查相比，评估症状问卷、鼻窦X线摄影（SR）和计算机断层扫描（CT）对哮喘患者鼻病诊断的潜在作用。
共有124例患者完成了由胸科医生发放的关于鼻部症状的问卷。然后，他们接受了耳鼻喉科检查。同一天，独立进行了SR和CT扫描。
80.3%的患者在就诊前一个月有鼻部症状。耳鼻喉科检查正常的占8.1%（n = 10），诊断为鼻炎的占57.3%（n = 71），鼻窦炎的占14.5%（n = 18），鼻息肉的占20.2%（n = 25）。对于鼻炎，双侧鼻塞的阴性预测值为87.8%。SR和CT的敏感性和特异性均较低。对于鼻窦炎，鼻部症状的阴性预测值在85.4%至95.2%之间。鼻窦CT在诊断鼻窦炎方面至少与SR一样准确。在多变量分析中，只有CT扫描（评分≥12）似乎与鼻息肉的诊断显著相关。
在哮喘患者中，医生需要通过使用这种对鼻炎敏感且对排除鼻窦炎和鼻息肉具有良好阴性预测值的简单问卷，系统地询问鼻部症状的存在情况。
