Nangia Shweta, Giridher Vijay, Chawla Praveen
Department of ENT, Bhagwan Mahavir Hospital, H4-5, Pitampura, New Delhi, 110034 India.
T-10 (Ground Floor), Green Park Extension, New Delhi, 110016 India.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 3):1711-1717. doi: 10.1007/s12070-017-1060-2. Epub 2017 Jan 18.
The aims of this study were to assess the individual roles of nasal endoscopy (NE) and computed tomography (CT) in the diagnosis of chronic rhinosinusitis, to evaluate their sensitivity and specificity and determine the superiority of one over the other, if any. The study was conducted over 19 months on patients above 18 years of age attending the ENT OPD at Jaipur Golden Hospital, Rohini, Delhi with persistence of symptoms of chronic rhinosinusitis (CRS) for ≥12 weeks. NE was done in each patient followed by NCCT-PNS (4 mm cuts) evaluated with the Lund Mackay system and score ≥4 was suggestive of disease. On NE, mucopurulent discharge and edema in the middle meatus and ethmoid region were all seen in equal distribution amongst the patients. Polyps in the middle meatus were identified in the least number of patients. On observation for anatomical variants, paradoxical middle turbinate was seen in most patients and prominent agger nasi region in the least patients. On CT the order of involvement of the paranasal sinuses from most to least was-anterior ethmoids, maxillary sinus, posterior ethmoids, sphenoid and frontal sinuses. Ostiomeatal complex was involved in approximately one-third of the patients who had been diagnosed with CRS with CT. Frequency of disease on DNE and CT had a sensitivity of 72.2% and specificity of 63.6% with a value of 0.024, and positive and negative predictive values of 61.9 and 73.7% respectively. It was concluded at the end of the study that there was a significant correlation between DNE and CT in the diagnosis of CRS.
本研究的目的是评估鼻内镜检查（NE）和计算机断层扫描（CT）在慢性鼻窦炎诊断中的各自作用，评估它们的敏感性和特异性，并确定一方是否优于另一方。该研究在19个月内对年龄在18岁以上、在德里罗希尼的斋浦尔金医院耳鼻喉科门诊就诊、慢性鼻窦炎（CRS）症状持续≥12周的患者进行。对每位患者进行鼻内镜检查，随后进行鼻窦非增强计算机断层扫描（NCCT-PNS，4毫米层厚），采用Lund-Mackay系统评估，评分≥4提示患病。在鼻内镜检查中，患者中鼻道和筛窦区域的黏液脓性分泌物和水肿分布均等。中鼻道息肉在患者中发现的数量最少。在观察解剖变异时，大多数患者可见反常中鼻甲，最少患者可见明显的鼻丘区域。在CT上，鼻窦受累的顺序从多到少依次为：前筛窦、上颌窦、后筛窦、蝶窦和额窦。在经CT诊断为CRS的患者中，约三分之一的患者窦口鼻道复合体受累。鼻内镜检查（DNE）和CT诊断疾病的敏感性为72.2%，特异性为63.6%，P值为0.024，阳性和阴性预测值分别为61.9%和73.7%。研究结束时得出结论，在CRS诊断中，鼻内镜检查和CT之间存在显著相关性。
