Torretta S, Marchisio P, Esposito S, Cappadona M, Fattizzo M, Pignataro L
Department of Specialist Surgical Sciences, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Int J Pediatr Otorhinolaryngol. 2011 Jan;75(1):57-61. doi: 10.1016/j.ijporl.2010.10.007. Epub 2010 Oct 29.
We have previously compared the capacity of the nasal obstruction index (NOI) and nasal fiberoptic endoscopy (NFE) to detect adenoid hypertrophy (AH) in children and found no agreement between them. However, the prevalence of false positive results was significantly higher in children with allergic rhinitis (AR), thus suggesting that AR may be a possible causative factor. The aim of this study was to verify the diagnostic accuracy of the NOI in detecting AH by comparing NOI scores with NFE findings in a selected series of non-allergic children affected by nasal obstruction.
This prospective study was carried out at the Outpatient Clinics of the Departments of Specialist Surgical Sciences and Maternal and Pediatric Sciences of the University of Milan, Italy, and involved 154 non-allergic children aged 3-12 years in whom otological diseases and/or perceived nasal obstruction led to the suspicion of adenoid obstruction. The diagnostic accuracy of NOI was tested at all of the thresholds obtained by combining all of the cut-off points of NFE and NOI.
Sixty-two percent of the children had otological diseases. The choanal opening was completely blocked by the adenoids in 40% of the children, whereas NOI indicated severe clinical obstruction in only 16%. The analysis of diagnostic accuracy showed that sensitivity and specificity were respectively 17-96% and 15-91% depending on the threshold, with no simultaneously acceptable sensitivity and specificity values at any threshold and AUC values of ≤0.7 at all thresholds.
In comparison with NFE, the NOI seems to be inaccurate in detecting AH in non-allergic children with nasal obstruction.
我们之前比较了鼻阻塞指数（NOI）和鼻纤维内镜检查（NFE）检测儿童腺样体肥大（AH）的能力，发现二者之间并无一致性。然而，变应性鼻炎（AR）患儿的假阳性结果发生率显著更高，因此提示AR可能是一个潜在病因。本研究的目的是通过比较一组选定的因鼻阻塞而就诊的非变应性儿童的NOI评分和NFE检查结果，来验证NOI在检测AH方面的诊断准确性。
本前瞻性研究在意大利米兰大学专科外科科学系及母婴与儿科科学系门诊进行，纳入了154名3至12岁的非变应性儿童，这些儿童因耳部疾病和/或感觉到鼻阻塞而怀疑有腺样体阻塞。在通过合并NFE和NOI的所有切点所获得的所有阈值下，对NOI的诊断准确性进行了测试。
62%的儿童患有耳部疾病。40%的儿童后鼻孔开口被腺样体完全阻塞，而NOI仅显示16%有严重临床阻塞。诊断准确性分析表明，根据阈值不同，敏感性和特异性分别为17% - 96%和15% - 91%，在任何阈值下均无同时可接受的敏感性和特异性值，且所有阈值下的曲线下面积（AUC）值均≤0.7。
与NFE相比，NOI在检测有鼻阻塞的非变应性儿童的AH方面似乎不准确。
