The Diagnostic Accuracy of Computed Tomography in Pediatric Chronic Rhinosinusitis

Abstract

To determine the accuracy of computed tomography (CT) in the diagnosis of pediatric chronic rhinosinusitis (CRS).

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…1410 It is also believed that some children may have chronic adenoiditis with no CRS because symptoms of the 2 entities cannot be distinguished without CT scan of the sinuses. 1411 There is controversy whether the size of the adenoids matter in children with PCRS. Children with symptoms of RS who had a CT scan of the sinuses and underwent an adenoidectomy were investigated and results showed no correlation between the size of the adenoids and the severity of disease on CT scan.…”

“…In a study comparing 66 children with CRS symptoms to 192 control children having CT imaging for nonsinus indications, it was noted that children with a LM score of 5 or more had a sensitivity and specificity of 86% and 85%, respectively, of having CRS, whereas a CT score of 2 had an excellent negative predictive value of CRS, making the diagnosis of chronic adenoiditis more likely. 1411 It should be noted that use of CT should be reserved for when surgery is being considered and not utilized routinely to make the diagnosis of PCRS.…”

Factors associated with computed tomography status in patients presenting with a history of chronic rhinosinusitis

“…6,8 However, to exclude false positives, we considered scans with a score <3 negative, unless the disease distribution by CT correlated anatomically with the location of the patient's symptoms (eg, chronic unilateral frontal pressure in a patient with partial opacity of the ipsilateral maxillary and anterior ethmoid sinus, sans sinus disease elsewhere). In the pediatric population Bhattacharyya et al 9 found a Lund-Mackay score of ≥5 yields a sensitivity and specificity of 86% and 85%, respectively. No comparable study has been done in adults, so there continues to be no accepted cutoff.…”

Histopathological inflammation and symptom outcomes after endoscopic sinus surgery

“…Patients were included in the study according to the following inclusion criteria: age >16 years, satisfied diagnostic criteria (clinical symptom criteria and radiographic criteria) for CRS without nasal polyposis, failed standard medical management, underwent standard ESS with tissue submitted for histopathology, and pathology was available for review. 6,7 All patients completed a preoperative Rhinosinusitis Symptom Inventory (RSI), cataloging their symptom severity scores for the major and minor symptoms of CRS as well as their medication usage with respect to CRS. 1 For each patient, standard demographic information was collected and their scores on the individual elements of the RSI and RSI symptom domains (domains: nasal, facial, oropharyngeal, systemic, and total symptoms) were tabulated and calculated.…”