Computed Tomography Scans as an Objective Measure of Disease Severity in Chronic Rhinosinusitis

Abstract

Oral Presentations P125Objectives: Propose and validate a scoring system of the findings of sleep nasopharyngoscopy (SNP) for children with sleep disordered breathing (SBD). Methods:We conducted an inter-and intra-rater agreement study on video documentations of SNP performed on children (non-syndromic or dysmorphic) presenting with SDB. Videos used represented different types of pharyngeal findings including normal, collapse, mixed picture, or obstruction. Three "non-expert" raters at various stages in their otolaryngological career rated the videos twice and independently. One calculation assumed equal spacing between categories, the second assumed unequal spacing between the first and the second two based on need for surgical intervention.Results: Sixty-three videos were rated by each observer (2 weeks apart). None were syndromic or dysmorphic patients. Intraobserver agreement was 0.6442 ± 0.0835 (95%CI 0.4806-0.8078), 0.7373 ± 0.0718 (95%CI 0.5965-0.8781), 0.5853 ± 0.0789 (95%CI 0.4306-0.74), for raters 1, 2, and 3. Weighted kappa was 0.593 ± 0.1864 (95%CI 0.2277-0.9583), 0.85 ± 0.0884 (95%CI 0.6848-1), 0.79 ± 0.0772 (95%CI 0.6458-0.9506), respectively. Inter-rater agreements between raters 1 and 2, 2 and 3, 3 and 4 were 0.8304 ± 0.0604 (95%CI 0.7119-0.9489), 0.5168 ± 0.0827 (95%CI 0.3546-0.697), and 0.5306 ± 0.0829 (95%CI 0.368-0.693), respectively. Weighted kappa was 0.81 ± 0.1504 (95%CI 0.5231-1), 0.72 ± 0.1147 (95%CI 0.5-0.95), and 0.6658 ± 0.052 (95%CI 0.5253-0.8), respectively.Conclusions: This is the first proposed scoring method for SNP in children. It is based on a generic interpretation of SNP into four types. Overall reproducibility among the three raters and their agreement was good. Rhinology/AllergyAcute Dacryocystitis with Empyema of the Lacrimal sac: is immediate Endoscopic Dacryocystorhinostomy Justified? Davide Lombardi, MD (presenter); Davide Mattavelli, MD; Francesco Semeraro, MD; Piero Nicolai, MD Objectives: To evaluate the efficacy of endoscopic dacryocystorhinostomy (endoDCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE).Methods: Design: Single center cohort study. Setting: Academic tertiary center. Patients: Twenty-one consecutive patients who underwent endoDCR for ADLSE between August 2005 and December 2012 were included. Main outcome measures: The success of the procedure was defined as complete complaint relief and DCR patency. Time from referral to surgery, post-operative complications, and revision surgery data were also reported. Results:The present cohort of patients included 3 males (14.3%) and 18 females (85.7%) (median age: 66 years).Median time between referral and surgery was 0 days (mean: 0.86 days). Median follow-up was 12 months. All patients showed immediate relief from symptoms, with no recurrences of ADSLE. Complete success was achieved in 20 of 21 (95.2%) cases; the only failure was recorded in a patient who had previously undergone radio-iodine treatment. In this case also revision endoDCR was not successful. The only perioperative comp...

Association of air pollutants, airborne occupational exposures, and chronic rhinosinusitis disease severity

“…using the Zinreich modification of the Lund-Mackay scoring (LMS) system to quantify disease inflammation (interrater reliability = 92.6%, p < 0.05). 16 To further investigate the interaction between host and environmental factors on disease measures, patient occupations were recorded and categorized based on the 2010 version of the Standard Occupation Classification (SOC10). The 9 major groups consisted of: (1) managers and senior employees; (2) professional occupations; (3) associate professional and technical occupations; (4) administrative and secretarial occupations; (5) skilled trade occupations; (6) personal service occupations; (7) sales and customer service occupations, (8) process, plant, and machine operatives; (9) elementary occupations; and (10) retired and disabled individuals and students.…”

Correlation of Symptoms, Clinical Signs, and Biomarkers of Inflammation in Postsurgical Chronic Rhinosinusitis

“…Our study utilized a specific 2D anatomical slice obtained via CT, which has shown significantly greater correlation with 3D volumetric evaluation as well as significantly greater sensitivity to change compared to the Lund-Mackay system. 4,18…”

“…2 Recently, the use of a coronal 2D single slice image through the osteo-meatal complex (OMC) has been shown to be a valid representation of mucosal thickening in patients with CRS as this slice correlates well to 3D CT scans representing all the sinuses of the same patients. 4…”

Three-Dimensional Volumetric Evaluation of the Maxillary Sinuses in Chronic Rhinosinusitis Surgery

“…1-3 To assess actual physical changes, however, objective assessment methods, which for CRS are based on computed tomographic (CT) or cone-beam CT (CBCT) scans, are needed. 4,5 In CT and CBCT imaging, the results are estimated from the changes in the thickness of the mucous membrane in the nasal sinuses.…”