Leo G, Incorvaia C, Masieri S, Triulzi F
Pediatric Allergy and Respiratory Pathophysiology Unit, Buzzi Children's Hospital, Milan, Italy.
Eur Ann Allergy Clin Immunol. 2010 Dec;42(6):199-204.
Symptoms of chronic rhinosinusitis (CRS) are nasal blockage, nasal discharge, postnasal drip, facial pain, headache, and reduction or loss of smell, but they are often subtle and make it difficult to obtain a firm diagnosis based only on clinical data, and especially to distinguish CRS from persistent rhinitis. A diagnosis of certainty of CRS relies upon either direct observation by nasal fibroendoscopy of nasal turbinates, middle meatus, and rhinopharynx, detecting mucopurulent discharge from the middle meatus, and/or oedema or mucosal obstruction, or by imaging of the rhinosinusal cavities. Imaging techniques such as computed tomography (CT) scanning and magnetic resonance (MR) are currently recommended in consensus documents, while plain radiography is considered of poor diagnostic value. However, recent studies indicated that radiography by the Waters'projection had a sensitivity of 84.2% and a specificity of 76.6%, which suggests to use it routinely in suspected CRS, limiting the number of more expensive imaging investigations. This seems important in the current economic landscape that requires a cost-effectiveness evaluation in each diagnostic procedure.
慢性鼻-鼻窦炎（CRS）的症状包括鼻塞、流涕、鼻后滴漏、面部疼痛、头痛以及嗅觉减退或丧失，但这些症状往往较为隐匿，仅依据临床数据很难做出确切诊断，尤其是难以将CRS与持续性鼻炎区分开来。CRS的确切诊断依赖于通过鼻纤维内镜直接观察鼻甲、中鼻道和鼻咽部，检测中鼻道的黏液脓性分泌物和/或水肿或黏膜阻塞情况，或者通过鼻窦腔成像来确定。目前，共识文件推荐使用计算机断层扫描（CT）和磁共振成像（MR）等成像技术，而普通X线摄影的诊断价值被认为较差。然而，最近的研究表明，华氏位X线摄影的敏感性为84.2%，特异性为76.6%，这表明在疑似CRS的病例中可常规使用该方法，从而减少更昂贵的成像检查的次数。在当前需要对每个诊断程序进行成本效益评估的经济环境下，这似乎很重要。
