Deosthale Nitin V, Khadakkar Sonali P, Harkare Vivek V, Dhoke Priti R, Dhote Kanchan S, Soni Asha Jadia, Katke Ashwini B
Department of ENT, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur, Maharashtra 440019 India.
Indian J Otolaryngol Head Neck Surg. 2017 Dec;69(4):494-499. doi: 10.1007/s12070-017-1232-0. Epub 2017 Oct 17.
The study was done with the aims to evaluate the accuracy of nasal endoscopy as compared to computed tomography (CT) in diagnosing chronic rhinosinusitis (CRS) and to evaluate the correlation between Endoscopy Score and CT Score. It was a cross sectional study. Every consecutive, symptomatic patient of CRS who fulfilled the criteria of American Academy of Otolaryngology-Head and Neck Surgery Task Force were included in the study. Rigid diagnostic nasal endoscopy (DNE) was done and Lund-Kennedy scoring system was used. Plain CT of paranasal sinuses was done on the same day and severity was assessed using Lund-Mackay scoring system. Results were analysed considering CT as a gold standard. Out of 54 study patients, 45 (83.33%) had abnormal endoscopic examination while 50 (92.59%) were showing positive CT scan. Sensitivity and specificity of DNE against CT scan were 94% (95% CI 81.43-98.33%) and 75% (95% CI 42-99.24%), respectively. The positive predictive value was 98% and negative predictive value was 67%. Correlation between Lund-Mackay overall CT and Lund-Kennedy Endoscopy Score was high [Pearson's correlation coefficient (r) = 0.881, value < 0.0001]. The conclusion was drawn that, endoscopy is valuable in individuals with symptoms consistent with CRS and can be used to confirm the diagnosis and to know the severity of the disease. CT scan can be advised in those with high clinical suspicion of CRS but negative endoscopy and in those having persistent symptoms after optimum medical management requiring Functional Endoscopic Sinus Surgery.
本研究旨在评估鼻内镜检查与计算机断层扫描（CT）在诊断慢性鼻-鼻窦炎（CRS）方面的准确性，并评估内镜评分与CT评分之间的相关性。这是一项横断面研究。每一位符合美国耳鼻咽喉-头颈外科学会工作组标准的连续性、有症状的CRS患者均纳入本研究。进行了硬性诊断性鼻内镜检查（DNE），并采用Lund-Kennedy评分系统。在同一天进行了鼻窦平扫CT检查，并使用Lund-Mackay评分系统评估严重程度。以CT作为金标准对结果进行分析。在54例研究患者中，45例（83.33%）内镜检查异常，而50例（92.59%）CT扫描呈阳性。DNE相对于CT扫描的敏感性和特异性分别为94%（95%CI 81.43-98.33%）和75%（95%CI 42-99.24%）。阳性预测值为98%，阴性预测值为67%。Lund-Mackay总体CT评分与Lund-Kennedy内镜评分之间的相关性较高[Pearson相关系数（r）=0.881，P值<0.0001]。得出的结论是，内镜检查对有CRS相关症状的个体有价值，可用于确诊疾病并了解疾病的严重程度。对于临床高度怀疑CRS但内镜检查阴性的患者，以及在最佳药物治疗后仍有持续症状需要功能性内镜鼻窦手术的患者，可建议进行CT扫描。
