Is Nasal Endoscopy of Diagnostic Value in Chronic Rhinosinusitis Without Nasal Polyps?

Endoscopic examination of the nasal cavity is an integral part of the assessment of patients with chronic rhinosinusitis. However, the benefit gained by performing endoscopy with respect to the patient’s medical condition has not been completely assessed. We conducted a prospective cohort in an academic medical center. Thirty-nine patients diagnosed with chronic rhinosinusitis, without polyps, whose ailment was managed conservatively with no surgical intervention. All patients underwent nasal endoscopy, a computed tomography (CT) scan rated for Lund-MacKay score, and completed a sino nasal outcome test (SNOT)-20 questionnaire. This same evaluation was repeated 6 weeks following medical treatment. The CT scan and SNOT-20 questionnaire were independent parameters to evaluate the endoscopy score in each nasal passage. Thirty-nine (28 females) patients completed the follow-up period. A total of 156 endoscopic evaluations were performed, in which 74 nasal cavities were found to have significant pathology and 82 were either normal or displayed mild pathology. The correlation with the Lund-MacKay score was poor with a positive predictive value of 68.9% (31.1% false positive and 28% false negative). However, while looking at the SNOT-20 score, corrected for repeated measures, a higher endoscopy score was associated with a higher SNOT-20 score (odds ratio = 3.53, 95% confidence interval = 1.54-8.09, P = .003). Patients with higher endoscopy scores had a greater probability for exhibiting severe symptoms. However, we could not demonstrate a strong correlation between nasal endoscopy findings and CT scan scores. Therefore, with respect to patients with chronic rhinosinusitis without polyps, nasal endoscopy could be utilized as a beneficial objective tool.

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Usefulness of Nasal Endoscopy for Diagnosing Patients With Chronic Rhinosinusitis: A Meta-Analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892419892157 ◽

2019 ◽

Vol 34 (2) ◽

pp. 306-314

Author(s):

Do Hyun Kim ◽

Youngjun Seo ◽

Kyung Min Kim ◽

Seoungmin Lee ◽

Se Hwan Hwang

Keyword(s):

Diagnostic Accuracy ◽

Chronic Rhinosinusitis ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Characteristic Curve ◽

False Negative ◽

Nasal Endoscopy ◽

Summary Receiver Operating Characteristic ◽

True Negative ◽

Endoscopic Score

Background We evaluated the accuracy of nasal endoscopy in diagnosing chronic rhinosinusitis (CRS) compared with paranasal sinus computed tomography (CT). Methods Two authors independently searched the 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) up to March 2019. For all included studies, we calculated correlation coefficients between the endoscopic and CT scores. We extracted data on true-positive and false-positive and true-negative and false-negative results. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (version 2). Results We included 16 observational or retrospective studies. A high correlation ( r = .8543; 95% confidence interval [CI] [0.7685–0.9401], P < .0001, I2 = 76.58%) between endoscopy and CT in terms of the diagnostic accuracy for CRS was apparent. The odds ratio (Lund–Kennedy endoscopic score ≥1) was 7.915 (95% CI [4.435–14.124]; I2 = 28.361%). The area under the summary receiver operating characteristic curve was 0.765. The sensitivity and specificity were 0.726 (95% CI [0.584–0.834]) and 0.767 (95% CI [0.685–0.849]), respectively. However, high interstudy heterogeneity was evident given the different endoscopic score thresholds used (Lund–Kennedy endoscopic score ≥1 vs 2). In a subgroup analysis of studies using a Lund–Kennedy endoscopic score threshold ≥2, the area under the summary curve was 0.881, and the sensitivity and specificity were 0.874 (95% CI [0.783–0.930]) and 0.793 (95% CI [0.366–0.962]), respectively. Conclusion Nasal endoscopy is a useful diagnostic tool; the Lund–Kennedy score was comparable with that of CT.

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Recurrent Acute Rhinosinusitis

Otolaryngology ◽

10.1177/0194599811426089 ◽

2011 ◽

Vol 146 (2) ◽

pp. 307-312 ◽

Cited By ~ 42

Author(s):

Neil Bhattacharyya ◽

Jeff Grebner ◽

Noel G. Martinson

Keyword(s):

Computed Tomography ◽

Health Care ◽

Health Care Costs ◽

Medical Center ◽

Academic Medical Center ◽

Nasal Endoscopy ◽

Oral Antibiotic ◽

Medical Claims ◽

Acute Rhinosinusitis ◽

Care Costs

Objectives. To determine the epidemiology of recurrent acute rhinosinusitis (RARS) and to understand direct health care costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis. Study Design. Retrospective longitudinal analysis of a medical claims database. Setting. Academic medical center. Methods. Medical claims data (2003–2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Sinonasal diagnostic procedures, provider visits, and medical costs were determined. Results. A total of 4588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. RARS patients averaged 3.8 antibiotic prescriptions, 5.6 other sinus-related prescriptions, and 5.6 provider visits per year. Total direct health care costs related to RARS averaged $1091/patient-year, with oral antibiotic and nasal prescription costs averaging $210 and $452 per year, respectively. Conclusions. RARS may affect approximately 1 in 3000 adults per year. Despite significant direct health care costs of more than $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.

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False Loss of Resistance in Cervical Epidural Injection: The Loss of Resistance Technique Compared with the Epidrum Guidance in Locating Epidural Space

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.131 ◽

2016 ◽

Vol 3;19 (3;3) ◽

pp. 131-138

Author(s):

Dr. Woo Seog Sim

Keyword(s):

Epidural Space ◽

Medical Center ◽

Academic Medical Center ◽

False Negative ◽

Epidural Injection ◽

Epidural Block ◽

Epidural Injections ◽

Academic Medical ◽

Combined Use ◽

Loss Of Resistance

Background: Epidural block failures can occur due to a misleading loss of resistance (LOR) signal. Objective: This study was designed to evaluate the false LOR rate and to determine whether the Epidrum, which is an LOR device for identifying the epidural space, improves the ability to find the epidural space during cervical epidural injection compared the LOR technique. Study Design: A randomized, single-blind trial. Setting: Single academic medical center. Methods: A total of 150 patients undergoing cervical interlaminar epidural injections at C7-T1 were randomized to receive either the LOR technique with a syringe (group C) or the Epidrum guidance (group E). Fluoroscopic images were used to confirm the accuracy of the needle placement within the epidural space. The rate of misleading epidural signals and adverse effects were recorded and analyzed. Results: The false LOR rate was 74.7% for group C, 62.7% for group E, and 68.7% overall. The incidence of false LOR was not significantly different between the 2 groups. Also, the success rate and the rate of true epidural signals were similar between the 2 groups. Limitations: The Epidrum cannot be used to confirm whether the needle has entered the vascular space without fluoroscopy. Conclusions: In this study, we did not find any difference in accuracy between the Epidrum and the LOR technique with a syringe for detecting the cervical epidural space. The overall higher false LOR rate suggests that the combined use of fluoroscopy and LOR technique with a syringe or the Epidrum is necessary to increase the rate of finding the true cervical epidural space. Clinical Trials registration: KCT0001333 Key words: Cervical epidural injection, epidural space, Epidrum, false positive, false negative, loss of resistance

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Radiographic Characterization of Midfoot and Transverse Tarsal Joint Osteoarthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00157 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Alexander Caughman ◽

Christopher E. Gross

Keyword(s):

Ct Scan ◽

Medical Center ◽

Weight Bearing ◽

Academic Medical Center ◽

Operative Management ◽

X Rays ◽

Advanced Imaging ◽

Plain Radiographs ◽

X Ray ◽

Tarsal Joint

Category: Midfoot/Forefoot Introduction/Purpose: The burden of midfoot arthritis is staggering. Foot osteoarthritis affects over 16% of all adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management often culminates in fluoroscopic guidance injections. Its management is troublesome for surgeons as conservative treatment is maximized because its surgical solution is oftentimes fraught with nonunions and other complications. The purpose of this study was to see how well surgeons are able to predict midfoot and transverse tarsal joint osteoarthritis on x-rays as it compares to CT and MRI scans. Methods: We reviewed the records of 117 patients (146 feet) with a diagnosis code of midfoot osteoarthritis who were treated from 2015 to 2019 at an academic medical center by a single surgeon. The mean age was 63.2 +- 10.7 years. The average BMI was 31.2 +- 6.4. Each of those patients had both plain radiographs and either a CT or MRI scan. Patients had weight-bearing anteroposterior and lateral radiographs according to a standardized protocol. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis. We then compared how frequently a radiograph predicted an arthritic midfoot or transverse tarsal joint as compared to a CT scan or MRI using a paired t test. Results: The most common joints affected by arthritis were the 2nd TMT (83.5% by X-ray; 88.4% by CT) and 3rd TMT (71.9% by X-ray; 68.4% by CT). Advanced imaging showed a significantly higher rate of arthritis in the 1st, 4th, and 5th TMT as compared to X-rays. Only 20.2% of patients’ radiographs had a direct correlation with their CT scan. A CT scan showed one or two more affected joints by 23.6% and 17.6 % respectively, and rarely showed one or two less joints affected by arthritis, 6.8% and 0.6% respectively. Based on this data, a radiograph’s sensitivity and specificity vary wildly-from 86.0% and 57.8%, respectfully in the 3rd TMT to 43.8% and 96.0%, respectfully in the 1st TMT. Conclusion: Radiographs vary quite drastically in their sensitivities and specificities in diagnosing osteoarthritic joints in the midfoot and transverse tarsal joints. If intending to treat midfoot osteoarthritis with fluoroscopic injections, we recommend not relying on plain radiographs, but advanced imaging.

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Diagnosis of chronic rhinosinusitis: can nasal endoscopy be the new gold standard in developing countries?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20160066 ◽

2016 ◽

Vol 2 (1) ◽

pp. 30

Author(s):

Sushant Tyagi ◽

Mohit Srivastava ◽

Vandana Singh

Keyword(s):

Developing Countries ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Middle Turbinate ◽

Anatomical Variations ◽

Diagnostic Value ◽

Uncinate Process ◽

Nasal Endoscopy ◽

Deviated Nasal Septum ◽

Diagnostic Modality

Background: Objective of the study was to study the role of diagnostic value of nasal endoscopy in diseases involving nasal cavity and paranasal sinuses particularly chronic rhinosinusitis in developing countries.Methods: A total of 200 Patients with clinical evidence of sinonasal diseases were evaluated. All patients were subjected to thorough ENT examination with special emphasis on anterior and posterior rhinoscopy. Nasal Endoscopy was done using Hopkins rod endoscopes ( 0º, 30º, 45º, 70º and 90º) - diameter 2.7 mm/ 4 mm, length 18 cm after administering a spray puff of Xylocaine with adrenaline (10 drops of adrenaline to 2 ml of Xylocaine). Computed tomography of paranasal sinuses was done in 100 patients whose symptoms, examination and clinical picture were sufficient to warrant the procedure. Results: The most common anatomical variations detected on nasal endoscopy were deviated nasal septum (83.5%) followed by paradoxical middle turbinate (42.5), and concha bullosa (26.5%). Accessory middle turbinate was seen in 7 out of 200 cases (3.5%). The most common pathological abnormality detected on nasal endoscopy was mucopus in middle meatus (69%) and next were hypertrophied (45 and 35% inferior and middle turbinate respectively) and congested turbinates (44.5%), followed by polypoidal changes (28%) and oedematous/congested uncinate process (27.5%).Conclusion: Diagnostic nasal endoscopy can prove to be a better diagnostic modality compared to CT scan when conditions like middle meatal secretions, condition of mucosa, polyps are looked for. It can detect early polypoidal and other pathological changes missed on CT which can aid in early diagnosis and medical management of sinonasal diseases thereby preventing patient from unnecessary surgical exposure. Also being easily available and cost effective, patients can be spared from unnecessary cost and radiation exposure by performing diagnostic nasal endoscopy prior to CT.

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Diagnosing chronic rhinosinusitis: a comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213897 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1630

Author(s):

Dharmishtha H. Parmar ◽

Hiten R. Maniyar ◽

Hetna A. Patel

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Paranasal Sinuses ◽

Predictive Value ◽

Nasal Endoscopy ◽

P Value ◽

Computed Tomographic ◽

Heterogenous Group ◽

Operative Evaluation ◽

Accurate Procedure

Background: The term ‘rhinosinusitis’ refers to a heterogenous group of disorders characterized by inflammation of mucosa of the nose and paranasal sinuses. The National Institute of Allergy and Infectious Diseases (NIAID) have recently mentioned that 136 million people of India suffer from chronic rhino sinusitis.Methods: A total 50 patients with symptoms of rhinosinusitis were investigated with both diagnostic nasal endoscopy and CT scan paranasal sinuses and their findings were scored with particular scoring system and compared with each other. Results: Out of 50 patients, 90% patients were diagnosed on CT scan and 84% patients were diagnosed on nasal endoscopy. By considering CT scan as accurate procedure and correlating nasal endoscopy with CT scan, sensitivity was 88.88%, specificity was 60%, positive predictive value was 95.23%, negative predictive value was 37.5%, and p value was 0.004671, which was significant at p<0.05, indicates that CT paranasal sinuses is more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis.Conclusions: Both diagnostic nasal endoscopy and CT paranasal sinuses are important pre-operative evaluation tools in detecting pathology and both are complementary to each other. But CT paranasal sinuses are more convenient than endoscopy according to this study.

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A STUDY OF CORRELATION BETWEEN NASAL ENDOSCOPY AND CT SCAN IN CASES OF CHRONIC RHINOSINUSITIS

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2015/586 ◽

2015 ◽

Vol 2 (28) ◽

pp. 4128-4133

Author(s):

Arun Kumar Patel ◽

Aruna Patel ◽

Subhash Chand Jain ◽

Brijesh Singh

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Nasal Endoscopy

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Characterization, Categorization, and 5-Year Mortality of Medicine High Utilizer Inpatients

Journal of Palliative Care ◽

10.1177/0825859718769095 ◽

2018 ◽

Vol 33 (3) ◽

pp. 167-174 ◽

Cited By ~ 2

Author(s):

Joyeeta G. Dastidar ◽

Min Jiang

Keyword(s):

Palliative Care ◽

Medical Condition ◽

Medical Center ◽

Academic Medical Center ◽

Management Strategies ◽

General Medicine ◽

Emergency Department Visits ◽

Chronic Medical Condition ◽

Individualized Care ◽

Palliative Care Consultation

Background: Patients who are frequently admitted to Medicine inpatient services comprise a distinct subset of readmitted patients about whom not much is known. Objective: We sought to characterize this group including mortality rates, with the goal of better understanding this population. Design: Observational study of frequently hospitalized patients defined as 4 or more admissions over a 6-month period, with hospitalization defined as nonelective admission to the hospital. Setting: Single large academic medical center. Patients: Adult inpatients on general medicine and medicine subspecialty services. Measurements: The number of nonelective medicine hospitalizations, age, clinical conditions and comorbidities, calculation of an age-adjusted Charlson Comorbidity Index (CCI), outpatient and emergency department visits, length of stay, costs of hospitalization, and mortality over a 5-year period. Descriptive statistics were used to characterize variables of interest. Results: We identified 153 patients with a total of 781 nonelective hospitalizations, totaling greater than 4000 hospital days and with charges of approximately US$9 million during the 6 months. Nearly all had insurance coverage and good outpatient follow-up (median of 7 appointments over the 6-month study period). Only 14% of those admissions qualified for observation status. Over 40% of patients had comorbid mental health disease or chronic narcotic dependence. Twenty-nine percent of patients died within 1 year; 50% were dead within 5 years. Age-adjusted CCI scores ranged annually from 3.00 to 3.58 among surviving patients versus 4.31 to 6.60 among deceased patients. Conclusions: These findings point to distinct groups of patients who are frequently hospitalized, and therefore would benefit from tailored management strategies: Those with progression of end-stage disease comprised one-third of the group and targeting that subset with palliative care referrals could help decrease readmission rates. Those with recurrent exacerbations of a chronic medical condition could be managed through telemanagement programs. Those with exacerbations of chronic pain could be addressed through collaboration with pain management specialists. Individualized care management plans may be useful for all, especially the latter two groups. Based on differences between survivors and deceased patients, an age-adjusted CCI score of 4 or 5 could be valuable sensitive or specific cutoffs, respectively, for predicting those who would benefit most from palliative care consultation regarding end-of-life goals and management.

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A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

10.21203/rs.3.rs-31703/v1 ◽

2020 ◽

Author(s):

Farshid Rahimibashar ◽

Andrew Carl Miller ◽

Mojtaba H. Yaghoobi ◽

Amir Vahedian-Azimi

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Medical Center ◽

Academic Medical Center ◽

False Negative ◽

Youden Index ◽

Ventilator Associated Pneumonia ◽

Reference Standard ◽

Male Predominance ◽

Diagnostic Algorithms

Abstract BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

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A comparative analysis of CT scan versus diagnostic nasal endoscopy in chronic rhino sinusitis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182401 ◽

2018 ◽

Vol 4 (4) ◽

pp. 930

Author(s):

Ahamed Nauphal Pullarat ◽

Shakeeber Kottayil ◽

Girish Raj ◽

Basheer N. K.

Keyword(s):

Ct Scan ◽

Chronic Rhinosinusitis ◽

Anatomical Variations ◽

Sinus Surgery ◽

Nasal Endoscopy ◽

Common Symptom ◽

Medical College ◽

Sinus Cavity ◽

Chronic Rhino Sinusitis ◽

Extent Of Disease

Background: With the advent of nasal endoscopy (DNE) and computed tomography (CT) in the evaluation of patients with chronic rhinosinusitis, it has popularized the functional endoscopic sinus surgery. The objective of this study is to find out effectiveness and limitations of CT and DNE in chronic rhinosinusitis.Methods: Patients attending the Otorhinolaryngology outpatient department of MES medical college with chronic rhinosinusitis (CRS), who satisfy the inclusion criteria, were included in the study. They were given a course of antibiotics and antihistamines for a period of 10 days prior to CT Nose & PNS followed by an interval of 5 days nasal endoscopy done and findings were compared. Results: In this study, 58% cases were males and 42% females, most common symptom was a headache (76%). In DNE 82% cases had septal deviation and 86% in CT scan. Most common sinus cavity involved in CT scan was maxillary sinus.Conclusions: CT scan has got a better advantage compared to DNE in detecting the anatomical variations as well as to know the condition of the sinus cavity and the extent of disease in sinuses. In conditions like middle meatal secretions, mucosal change, polyp DNE gave a better picture of the condition. Both DNE and CT scan are complementary to each other in CRS.

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