Krishniya Pratibha, Rajpurohit Pragya, Sharma Vikrant Kumar, Aseri Yogesh, Verma P C
Department of Otorhinolaryngology and Head and Neck Surgery, Jawahar Lal Nehru Medical College, Ajmer, India.
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):4706-4712. doi: 10.1007/s12070-021-03030-9. Epub 2022 Jan 17.
In order to diagnose chronic rhinosinusitis (CRS), diagnostic nasal endoscopy (DNE) and computed tomography (CT) scan both are important investigations. But both have their pros and cons, some findings are seen better in DNE and others in CT. Our study aims to correlate DNE and CT findings. 50 patients with CRS were included in this observational prospective study done at tertiary care hospital. Preoperative each patient underwent DNE and got CT scan followed by scoring using Lund Kennedy and Lund Mackay grading respectively. Functional Endoscopic Sinus Surgery (FESS) was performed and intraoperative findings were correlated with CT scan for each of them. The sensitivity of endoscopy was 93.18% and the specificity was 83.33%. Positive predictive value of DNE was 97.62% and negative predictive value was 62.50%. Most of the endoscopy positive patients of CRS were CT positive. Also, the sensitivity of CT PNS was highest for all groups of sinus disease while specificity was high for posterior group of sinuses (81.82%) and frontal sinus (89.19%). Both DNE and CT scan should be used for planning the management of CRS. DNE tells better about middle meatal secretions, condition of mucosa, polyps. But in situations where due to anatomical variation DNE is difficult, CT scan helps us. CT identifies the extent of disease, the anatomical variants and vital relations of PNS. Overdiagnosis through CT is checked by DNE.
为了诊断慢性鼻-鼻窦炎（CRS），诊断性鼻内镜检查（DNE）和计算机断层扫描（CT）都是重要的检查手段。但两者都有其优缺点，有些发现通过DNE看得更清楚，而有些则在CT上更明显。我们的研究旨在关联DNE和CT的检查结果。本观察性前瞻性研究纳入了50例在三级医院就诊的CRS患者。术前，每位患者均接受了DNE检查并进行了CT扫描，随后分别采用Lund Kennedy和Lund Mackay分级系统进行评分。所有患者均接受了功能性鼻内镜鼻窦手术（FESS），并将术中发现与各自的CT扫描结果进行关联分析。鼻内镜检查的敏感性为93.18%，特异性为83.33%。DNE的阳性预测值为97.62%，阴性预测值为62.50%。大多数CRS鼻内镜检查阳性的患者CT检查也呈阳性。此外，CT鼻窦平扫对所有鼻窦疾病组的敏感性最高，而后组鼻窦（81.82%）和额窦（89.19%）的特异性较高。DNE和CT扫描均应用于规划CRS的治疗方案。DNE能更好地显示中鼻道分泌物、黏膜状况和息肉情况。但在因解剖变异导致DNE操作困难的情况下，CT扫描会有所帮助。CT可确定疾病范围、解剖变异以及鼻窦的重要关系。通过DNE可检查CT的过度诊断情况。
