Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Otolaryngol Head Neck Surg. 2014 Mar;150(3):359-64. doi: 10.1177/0194599813514510. Epub 2013 Dec 9.
To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis.
PubMed, EMBASE, and the Cochrane Library.
A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data.
Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%.
Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.
评估成人疑似慢性鼻-鼻窦炎患者鼻内镜检查结果的诊断价值。
PubMed、EMBASE 和 Cochrane 图书馆。
全面检索截至 2013 年 3 月 5 日的文献。纳入评估成人疑似慢性鼻-鼻窦炎患者鼻内镜检查诊断价值的研究。对入选文献，评估其研究设计的证据直接程度和偏倚风险。从报道的数据中提取患病率、阳性预测值和阴性预测值。
从 3899 篇独特的文献中，我们纳入了 3 项诊断研究，这些研究具有较高的证据直接程度和较低或中度的偏倚风险，用于数据提取。这些研究显示，慢性鼻-鼻窦炎（计算机断层扫描诊断）的患病率为.40 至.56。与后验概率相比，我们发现阳性鼻内镜检查对确诊慢性鼻-鼻窦炎的附加价值为 25%至 28%，阴性鼻内镜检查对排除慢性鼻-鼻窦炎的附加价值为 5%至 30%。
在鼻内镜检查阳性的情况下，不考虑进行计算机断层扫描。虽然鼻内镜检查不能排除慢性鼻-鼻窦炎，但我们建议仅对病程延长或复杂的鼻窦炎患者进行计算机断层扫描。
