scholarly journals The Diagnostic Value of Traditional Nasal Examination Tools in an Endoscopic Era

2019 ◽  
pp. 014556131987571
Author(s):  
Seksun Chainansamit ◽  
Chonthicha Chit-uea-ophat ◽  
Wisoot Reechaipichitkul ◽  
Patorn Piromchai
Keyword(s):  
Diagnostic Value ◽  
Nasal Symptom ◽  
Topical Anesthesia ◽  
Diagnostic Study ◽  
Nasal Endoscope ◽  
Clinical Sensitivity ◽  
Examination Methods ◽  
The Mean ◽  
Rule Out ◽  
Posterior Rhinoscopy

Background: As the endoscope has become more common in the otolaryngologist’s office, there is a need to reevaluate the value of traditional nasal examination methods. The objective of this study was to determine the sensitivity and specificity of traditional nasal examination tools compared to those of the rigid endoscope. Methods: A prospective diagnostic study was conducted. Eligible patients with nasal symptoms were recruited and examined using 4 tools: (1) a nasal speculum, (2) an otoscope, (3) a posterior rhinoscopy mirror, and (4) a rigid nasal endoscope. The diagnostic value of each tool was evaluated. Results: There were a total of 53 patients eligible for inclusion in the study. The mean age of all patients was 40.9 years. The most common nasal symptom was nasal obstruction (90.6%). With regard to the tools used in anterior rhinoscopy, the nasal speculum had a sensitivity of 54.69% (95% confidence interval [95% CI]: 41.75-67.18) and specificity of 88.10% (95% CI: 74.37-96.02); and the otoscope had a sensitivity of 57.81% (95% CI: 44.82-70.06) and specificity of 85.71% (95% CI: 71.46-94.57). After application of topical anesthesia and decongestant, the nasal speculum had a sensitivity of 67.19% (95% CI: 54.31-78.41) and specificity of 85.71% (95% CI: 71.46-94.57); and the otoscope had a sensitivity of 65.62% (95% CI: 52.70-77.05) and specificity of 83.33% (95% CI: 68.64-93.03). The posterior rhinoscopy mirror had a sensitivity of 12.50% (95% CI: 5.18-24.07) and specificity of 94.00% (95% CI: 83.45-98.75). All adverse events in this study were minor. Conclusion: The traditional nasal examination tools exhibited excellent specificity. However, the sensitivity was only average, meaning that they may not be suitable for screening. We do not recommend routine use of topical anesthesia and decongestants when applying these tools, as the application of these agents did not improve the clinical sensitivity or specificity. The posterior rhinoscopy mirror had a lowest sensitivity. We thus do not recommend using a posterior rhinoscopy mirror to rule out pathologies of the posterior nasal cavity.

scholarly journals Endoscopic Management of Nasal Myiasis: A 10 Years Experience

2013 ◽  
Vol 6 (1) ◽  
pp. 58-60 ◽  
Author(s):  
Arpit Agrawal ◽  
Anuj Goyal ◽  
SPS Yadav ◽  
Rupender K Ranga
Keyword(s):  
Conventional Technique ◽  
Nasal Symptom ◽  
Endoscopic Management ◽  
Control Group ◽  
Endoscopic Removal ◽  
Nasal Endoscope ◽  
The Mean ◽  
The Difference ◽  
Nasal Myiasis ◽  
Manual Extraction

ABSTRACT Background The present study was undertaken to compare the efficacy of endoscopic removal with conventional techniques in nasal myiasis patients. Materials and methods Out of 144, 72 nasal myiasis patients treated using Hopkins rigid nasal endoscope and visible caudal end of maggots was grasped with Blakesley forceps and removed during endoscopy. Rests were identified from crawling movements or the visible caudal end was buried in necrotic material. Complete clearance of cavernous cavity of maggots in affected nasal cavity from anterior nares to choanae was done and same was repeated on other side if needed. Results The mean age in two groups was 57.5 years (range 40-60) in nasal myiasis patients whereas there were 20% males and 80% females. Mean duration of nasal symptom in both groups was 2 days. Endoscopically mean 120 maggots (range: 90-160) were removed in first sitting as compared to conventional technique where mean of 80 (range: 40-90) were achieved. The mean duration of endoscopic treatment was 2 days whereas in control group it was 5 days. The difference was statistically significant (p < 0.001). Conclusion Nasal endoscopic procedure is superior to the manual extraction method for removal of maggots. The larvae located in deep and inaccessible areas can be identified and removed easily. The disease was controlled in shorter time and in fewer sittings. Further the quick and complete eradication of myiasis ensures less damage to the intranasal tissues. How to cite this article Ranga RK, Yadav SPS, Goyal A, Agrawal A. Endoscopic Management of Nasal Myiasis: A 10 years Experience. Clin Rhinol An Int J 2013;6(1):58-60.

Effectiveness of adenotonsillectomy in improving of nocturnal enuresis in children with adenotonsillar hypertrophy

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Kassim R Dekhil ◽  
Ali abd-almer Jwad ◽  
Abbas Alyasiry
Keyword(s):  
Teaching Hospital ◽  
Nocturnal Enuresis ◽  
Adenotonsillar Hypertrophy ◽  
Number Of Children ◽  
The Mean ◽  
Childhood Condition ◽  
Rule Out

Nocturnal enuresis (NE) is an old & common childhood condition. It has been found that,there is a relationship between adenotonsillar hypertrophy in children & nocturnal enuresis. This study was conducted to see the effects of adenotonsillectomy on nocturnal enuresis in children with adenotonsillar hypertrophy.This study was conducted in Diwaniyah teaching hospital,Diwaniyah city,Iraq from May 2012 to August 2014. The total number of children admitted for adenotonsillectomy or tonsillectomy alone were 287. 76 children out of the total number were included in the study. The children were followed by the same questionnaire for four months postoperatively,including,age,the number of night bed wettings,type of enuresis and the results of urine examinationof total 287 children who were submitted for surgery,76 children were eligible for the study,48 (63.16%) of the total number included in the study were males and 28 (36.84%) were females. The mean age was 7.2 years. Adenotonsillectomy was performed in 64 children,and tonsillectomy in12 children. A complete improvement of nocturnal enuresis (NE) & daytime incontinence was achieved in 32 (42.11%) children. A mild to moderateimprovement was observed in 38 (50%),while no improvement seen in the remaining 6 (7.89%) children postoperatively.Nocturnal enuresis (NE) is an old & common childhood condition & there is a relation between nocturnal enuresis in children & adenotonsillar hypertrophy. Children with nocturnal enuresis should be evaluated by ENT surgeon to rule out any adenotonsillar hypertrophy for possible adenotonsillectomy effect. However,a wide base studies are needed to clarify these results.

scholarly journals P170 The validity and utility of the SLE-key® rule-out serological test when applied in a selected cohort of patients with SLE and other connective tissue diseases

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Sheilla Achieng ◽  
John A Reynolds ◽  
Ian N Bruce ◽  
Marwan Bukhari
Keyword(s):  
Linear Regression ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Negative Correlation ◽  
Connective Tissue Diseases ◽  
Inflammatory Myositis ◽  
The Mean ◽  
Negative Rule ◽  
Spearman’S Correlation ◽  
Rule Out

Abstract Background/Aims  We aimed to establish the validity of the SLE-key® rule-out test and analyse its utility in distinguishing systemic lupus erythematosus (SLE) from other autoimmune rheumatic connective tissue diseases. Methods  We used data from the Lupus Extended Autoimmune Phenotype (LEAP) study, which included a representative cross-sectional sample of patients with a variety of rheumatic connective tissue diseases, including SLE, mixed connective tissue disease (MCTD), inflammatory myositis, systemic sclerosis, primary Sjögren’s syndrome and undifferentiated connective tissue disease (UCTD). The modified 1997 ACR criteria were used to classify patients with SLE. Banked serum samples were sent to Immune-Array’s CLIA- certified laboratory Veracis (Richmond, VA) for testing. Patients were assigned test scores between 0 and 1 where a score of 0 was considered a negative rule-out test (i.e. SLE cannot be excluded) whilst a score of 1 was assigned for a positive rule-out test (i.e. SLE excluded). Performance measures were used to assess the test’s validity and measures of association determined using linear regression and Spearman’s correlation. Results  Our study included a total of 155 patients of whom 66 had SLE. The mean age in the SLE group was 44.2 years (SD 13.04). 146 patients (94.1%) were female. 84 (54.2%) patients from the entire cohort had ACR SLE scores of ≤ 3 whilst 71 (45.8%) had ACR SLE scores ≥ 4. The mean ACR SLE total score for the SLE patients was 4.85 (SD 1.67), ranging from 2 to 8, with mean disease duration of 12.9 years. The Sensitivity of the SLE-Key® Rule-Out test in diagnosing SLE from other connective tissue diseases was 54.5%, specificity was 44.9%, PPV 42.4% and NPV 57.1 %. 45% of the SLE patients had a positive rule-out test. SLE could not be ruled out in 73% of the MCTD patients whilst 51% of the UCTD patients had a positive Rule-Out test and &gt;85% of the inflammatory myositis patients had a negative rule-out test. ROC analysis generated an AUC of 0.525 illustrating weak class separation capacity. Linear regression established a negative correlation between the SLE-key Rule-Out score and ACR SLE total scores. Spearman’s correlation was run to determine the relationship between ACR SLE total scores and SLE-key rule-out score and showed very weak negative correlation (rs = -0.0815, n = 155, p = 0.313). Conclusion  Our findings demonstrate that when applied in clinical practice in a rheumatology CTD clinic setting, the SLE-key® rule-out test does not accurately distinguish SLE from other CTDs. The development of a robust test that could achieve this would be pivotal. It is however important to highlight that the test was designed to distinguish healthy subjects from SLE patients and not for the purpose of differentiating SLE from other connective tissue diseases. Disclosure  S. Achieng: None. J.A. Reynolds: None. I.N. Bruce: Other; I.N.B is a National Institute for Health Research (NIHR) Senior Investigator and is funded by the NIHR Manchester Biomedical Research Centre. M. Bukhari: None.

Can the Expiratory Disproportion Index Distinguish PVFMD from Subglottic Stenosis in Obese Patients?

2021 ◽  
pp. 000348942199015
Author(s):  
Kevin Calamari ◽  
Stephen Politano ◽  
Laura Matrka
Keyword(s):  
Vocal Fold ◽  
Forced Expiratory Volume ◽  
Subglottic Stenosis ◽  
Obese Patients ◽  
Level Of Evidence ◽  
Prior Literature ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Paradoxical Vocal Fold Movement ◽  
Rule Out

Objectives: Expiratory disproportion index (EDI) is the ratio of forced expiratory volume in 1 second (FEV1) divided by peak expiratory flow rate (PEFR) multiplied by 100. Prominent EDI (>50) values can differentiate subglottic stenosis (SGS) from paradoxical vocal fold movement disorder (PVFMD), but this has not been verified when considering body habitus. We hypothesize that the predictive value of elevated EDI in differentiating SGS from PVFMD will be lower in obese patients than non-obese patients. Methods: Patients ≥ 18 years old with recorded PFT values, BMI, and airway imaging were reviewed retrospectively from 01/2011 to 10/2018. EDI was recorded for 4 cohorts: non-obese/SGS, non-obese/ PVFMD, obese/SGS, and obese/ PVFMD, to determine the mean EDI and the sensitivity/specificity of an elevated EDI. Results: Mean EDI values were 69.32 and 48.38 in the non-obese SGS and PVFMD groups, respectively ( P < .01). They were 58.89 and 47.67 in the obese SGS and PVFMD groups, respectively ( P < .05). At a threshold of >50, EDI had a sensitivity of 90.0% and specificity of 51.6% in differentiating between SGS and PVFMD cases in non-obese patients and 51.6% and 63.6% in obese patients. Conclusion: Prior literature has established that EDI can distinguish SGS from PVFMD in the general population. Our results show that the mean EDI values were significantly different in both cohorts, but an elevated EDI was not as sensitive at identifying SGS cases in obese patients. This suggests that the EDI should be used with caution in obese patients and should not be relied upon to rule out SGS. Level of Evidence: 3.

scholarly journals Chlamydia trachomatis intra-bacterial and total plasmid copy number in clinical urogenital samples

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. A. M. C. Dirks ◽  
K. Janssen ◽  
C. J. P. A. Hoebe ◽  
T. H. B. Geelen ◽  
M. Lucchesi ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Diagnostic Value ◽  
Plasmid Copy Number ◽  
Extracellular Dna ◽  
Chromosomal Dna ◽  
Plasmid Copy ◽  
Clinical Sensitivity ◽  
Copy Numbers ◽  
Vaginal Swabs ◽  
And Gender

AbstractChlamydia trachomatis (CT) increases its plasmid numbers when stressed, as occurs in clinical trachoma samples. Most CT tests target the plasmid to increase the test sensitivity, but some only target the chromosome. We investigated clinical urogenital samples for total plasmid copy numbers to assess its diagnostic value and intra-bacterial plasmid copy numbers to assess its natural variation. Both plasmid and chromosome copies were quantified using qPCR, and the plasmid:chromosome ratio (PCr) calculated in two cohorts: (1) 383 urogenital samples for the total PCR (tPCr), and (2) 42 vaginal swabs, with one half treated with propium-monoazide (PMA) to prevent the quantification of extracellular DNA and the other half untreated to allow for both tPCr and intra-bacterial PCr (iPCr) quantification. Mann–Whitney U tests compared PCr between samples, in relation to age and gender. Cohort 1: tPCr varied greatly (1–677, median 16). Median tPCr was significantly higher in urines than vaginal swabs (32 vs. 11, p < 0.001). Cohort 2: iPCr was more stable than tPCr (range 0.1–3 vs. 1–11). To conclude, tPCr in urogenital samples was much more variable than previously described. Transport time and temperature influences DNA degradation, impacting chromosomal DNA more than plasmids and urine more than vaginal samples. Data supports a plasmid target in CT screening assays to increase clinical sensitivity.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Performance of five D-dimer assays for the exclusion of symptomatic distal leg vein thrombosis

2012 ◽  
Vol 107 (02) ◽  
pp. 369-378 ◽  
Author(s):  
Jan Schwonberg ◽  
Carola Hecking ◽  
Marc Schindewolf ◽  
Dimitrios Zgouras ◽  
Susanne Lehmeyer ◽  
...  
Keyword(s):  
High Sensitivity ◽  
Diagnostic Value ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
Wells Score ◽  
Deep Vein ◽  
Test Result ◽  
D Dimer ◽  
Rule Out ◽  
Compression Ultrasonography

SummaryThe diagnostic value of D-dimer (DD) in the exclusion of proximal deep-vein thrombosis (DVT) is well-established but is less well-known in the exclusion of distal (infrapopliteal) DVT. Therefore, we evaluated the diagnostic abilities of five DD assays (Vidas-DD, Liatest-DD, HemosIL-DD, HemosIL-DDHS, Innovance-DD) for excluding symptomatic proximal and distal leg DVT. A total of 243 outpatients whose symptoms were suggestive of DVT received complete compression ultrasonography (cCUS) of the symptomatic leg(s). The clinical probability of DVT (PTP) was assessed by Wells score. Thirty-eight proximal and 31 distal DVTs (17 tibial/fibular DVTs, 14 muscle DVTs) were diagnosed by cCUS. Although all assays showed high sensitivity for proximal DVT (range 97–100%), the sensitivity was poor for distal DVT (range 78–93%). None of the assays were individually able to rule out all DVTs as a stand-alone test (negative predictive value [NPV] 91–96%). However, a negative DD test result combined with a low PTP exhibited a NPV of 100% for all DVTs (including proximal, tibial/fibular, and muscle DVTs) with the HemosIL-DDHS and Innovance-DD. All proximal and tibial/fibular DVTs, but not all muscle DVTs, could be ruled out with this strategy using the Liatest-DD and Vidas-DD. The HemosIL-DD could not exclude distal leg DVT, even in combination with a low PTP. The combination of a negative DD with a low PTP showed a specificity of 32–35% for all DVTs. In conclusion, our study shows that when used in conjunction with a low PTP some DD assays are useful tools for the exclusion of distal leg DVT.

STUDIES IN THE RELATION OF THE HEMOLYTIC STREPTOCOCCUS TO RHEUMATIC FEVER

PEDIATRICS ◽  
1949 ◽  
Vol 3 (4) ◽  
pp. 482-503
Author(s):  
T. N. HARRIS ◽  
SUSANNA HARRIS ◽  
RUTH L. NAGLE
Keyword(s):  
Rheumatic Fever ◽  
Streptococcal Infection ◽  
Laboratory Diagnosis ◽  
Diagnostic Value ◽  
The Other ◽  
Streptococcal Infections ◽  
Hemolytic Streptococcus ◽  
Streptococcal Antigens ◽  
The Mean

Titrations of antibodies to four streptococcal antigens have been carried out in the sera of patients with rheumatic fever and of convalescents from streptococcal infections. These antigens are the hyaluronidase, the hemolysin, and two somatic fractions, the cytoplasmic particles and supernate proteins. Mean titers to all of these antigens were elevated in both rheumatic and streptococcal infection. The mean titer was somewhat higher in rheumatic than in streptococcal infection in the case of three of these antibodies. In the case of the fourth, antihyaluronidase, this difference was considerably greater. The antihyaluronidase titer showed better correlation with changes in the activity of the rheumatic infection than did the other tests. There was, however, no striking correlation between this titer and the severity of the illness. Application was made of these findings to the problem of laboratory diagnosis of rheumatic fever by streptococcal serology. A method is presented for assessing the relative usefulness of such tests in terms of the, distribution of their titers in this disease and in health. By this method the antihyaluronidase test was found to be most useful of the four. The comparative diagnostic value for rheumatic fever was studied in the case of the antihyaluronidase test, the antistreptolysin test, and of combinations of both tests.

scholarly journals Efektivitas salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung penderita rinitis alergi

2018 ◽  
Vol 47 (2) ◽  
pp. 123
Author(s):  
Woro Safitri ◽  
Dwi Reno Pawarti ◽  
Titiek Hidayati Ahadiah
Keyword(s):  
Clinical Trial ◽  
Allergic Rhinitis ◽  
Symptom Score ◽  
Saline Group ◽  
Nasal Symptom ◽  
Control Group ◽  
Mucociliary Transport ◽  
Transport Time ◽  
Total Nasal Symptom Score ◽  
The Mean

Latar belakang: Rinitis alergi (RA) adalah suatu penyakit inflamasi mukosa hidung yang diperantara oleh imunoglobulin E (IgE), setelah mukosa hidung terpapar alergen. Tujuan: Mengidentifikasi efektivitas cuci hidung salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung total (SGHT) pada penderita RA. Metode: Penelitian dilaksanakan pada bulan Juli hingga Desember 2016 di Poli Telinga Hidung Tenggorok – Bedah Kepala Leher Rumah Sakit Dr. Soetomo Surabaya. Uji klinis acak terkontrol pada 2 kelompok dengan desain control group in clinical trial. Pengambilan sampel dilakukan secara consecutive sampling. Uji korelasi yang digunakan adalah uji t berpasangan dan uji Wilcoxon. Hasil: Didapatkan sampel 42 penderita, yaitu 21 penderita pada kelompok loratadin, serta 21 penderita pada kelompok loratadin dan cuci hidung salin hipertonik. Didapatkan rerata penurunan transpor mukosiliar kelompok loratadin dan cuci hidung salin hipertonik lebih bermakna daripada kelompok loratadin (p=0,001). Penurunan transpor mukosiliar kelompok loratadin didapatkan rerata -2,30 (SD=2,77), kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -6,27 (SD=3,91). Penurunan SGHT kelompok loratadin didapatkan rerata -2,48 (SD=1,72), sedangkan kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -4,3 (SD=1,20). Kesimpulan: Penambahan cuci hidung salin hipertonik pada terapi loratadin lebih efektif dibandingkan terapi tunggal loratadin dalam menurunkan transpor mukosiliar dan SGHT pada penderita RA. Kata kunci: Loratadin, cuci hidung salin hipertonik, transpor mukosiliar, skor gejala hidung total, rinitis alergi ABSTRACT Background: Allergic rhinitis (AR) is a nasal mucous membrane inflamatory which mediated by Imunoglobulin E (IgE) after allergen exposure in nasal mucosa. Purpose: To identify the effectiveness of nasal hypertonic saline irrigation on reduction of mucociliary transport time (MCTT) and total nasal symptom score (TNSS) in AR patients. Methods: The was conducted from July until December 2016 in Oto Rhino Laryngology - Head and Neck Surgery of Dr. Soetomo Hospital Surabaya. The study was randomized controlled clinical trials on two groups, with the control group in clinical trial design. Paired t and Wilcoxon test was used as the correlation test. Results: There was 42 patients, 21 patients in loratadine group, and 21 patients in loratadine with hypertonic nasal saline group. The average of mucociliary transport time decrease of loratadine with hypertonic nasal saline group was more significant than loratadine group (p=0.001). The mean of decreasing mucociliary transport time in loratadine group was -2.30 (SD=2.77) and loratadine with hypertonic nasal saline group was -6.27 (SD=3.91). The mean of decreasing TNSS in loratadin group was -2.48 (SD=1.72), and loratadin with hypertonic nasal saline group was -4.3 (SD=1.20). Conclusions: The addition of hypertonic nasal saline in loratadine was more effective, compared to monotherapy of loratadine in decreasing mucociliary transport time and TNSS in patient with AR. Keywords: Loratadine, hypertonic nasal saline, mucociliary transport, total nasal symptom score, allergic rhinitis

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