| Evaluating the diagnosis of chronic rhinosinusitis based on clinical guidelines and endoscopy. | |
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MedLine Citation:
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PMID: 20620634 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To validate the diagnosis of chronic rhinosinusitis (CRS) according to recent clinical practice guidelines and determine the added utility of nasal endoscopy. STUDY DESIGN: Prospective diagnostic cohort study. SETTING: Academic medical center. SUBJECTS AND METHODS: A consecutive series of adult patients presenting for evaluation of CRS were prospectively studied with the use of the rhinosinusitis symptom inventory (RSI), nasal endoscopy, and sinus computed tomography (CT). Symptom scores were tabulated from the RSI. Nasal endoscopy was performed to evaluate for purulence or polyps. Sinus CT scans were scored with the Lund system, with the reviewers blinded to the RSI scores and endoscopic findings. The clinical diagnosis of CRS was determined on the basis of the published adult sinusitis guideline criteria and compared with the diagnostic gold standard, CT. RESULTS: A total of 202 patients were studied. The prevalence of CRS was 39.6 percent, as defined by CT (Lund score > or = 4). For symptom criteria alone, the sensitivity, specificity, positive predictive value, and negative predictive value were 88.7, 12.3, 39.9, and 62.5 percent, respectively, for CRS (P = 0.82). The addition of endoscopic findings to symptom criteria significantly improved the specificity, predictive value, and negative predictive value to 84.1, 66.0, and 70.3 percent (P < 0.0001). The odds ratio of a true diagnosis of CRS improved from 1.1 to 4.6 (95% confidence interval, 2.3-9.2). Sensitivity analysis adjusting symptom severity did not significantly alter diagnostic accuracy. CONCLUSION: In patients meeting current guideline symptom criteria for CRS, the addition of nasal endoscopy improves diagnostic accuracy and should be emphasized as an early diagnostic tool. Diagnostic endoscopy may help reduce the use of CT, reducing costs and radiation exposure. |
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Authors:
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Neil Bhattacharyya; Linda N Lee |
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Publication Detail:
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Type: Comparative Study; Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Volume: 143 ISSN: 1097-6817 ISO Abbreviation: Otolaryngol Head Neck Surg Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-12 Completed Date: 2010-08-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8508176 Medline TA: Otolaryngol Head Neck Surg Country: United States |
Other Details:
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Languages: eng Pagination: 147-51 Citation Subset: IM |
Copyright Information:
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2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Division of Otolaryngology, Brigham and Women's Hospital, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA. neiloy@massmed.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Chronic Disease Endoscopy* Female Humans Male Middle Aged Practice Guidelines as Topic Predictive Value of Tests Reproducibility of Results Rhinitis / complications*, diagnosis*, therapy Severity of Illness Index Sinusitis / complications*, diagnosis*, therapy Tomography, X-Ray Computed |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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