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

Abstract

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.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…The addition of an objective measure improves the diagnostic accuracy 88,480,522 . While interrater variability on endoscopy for CRS exists, 528 the diagnostic accuracy of nasal endoscopy increases for patients with Lund‐Kennedy scores ≥2 253,529 . The addition of nasal endoscopy does not improve the diagnosis of CRS in patients who fail to meet the symptom guidelines (Table IX‐1 and X‐1).…”

“…Despite the high specificity and positive predictive value of nasal endoscopy in confirming a CRS diagnosis, endoscopy has been shown to be notably less sensitive, having false negative rates between 35% and 70%, when compared to CT 480,529,546,554–556 . The lower sensitivity is related to the inability of rigid and/or flexible endoscopy to assess the interior of all sinus cavities in un‐operated patients.…”

Canadian multidisciplinary expert consensus on the use of biologics in upper airways: A Delphi study

“…CT scan reports may indicate polyp disease but these reports are unreliable given difficulty in differentiating between polyps and thick, inflamed mucosal changes, which often accompany upper respiratory tract infections and/or asymptomatic changes in the non-diseased population [ 50 ]. Given CT scans have a lower specificity than nasal endoscopy as described in Statements 4 and 5, this imaging technique is not sufficient to rule in or diagnose CRSwNP [ 51 , 52 ]. Thus, to diagnose CRSwNP and initiate biologic therapy, the expert panel agrees that nasal endoscopy when available or anterior rhinoscopy where appropriate are the most reliable means of diagnosis.…”

Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification

“…FNE is performed for the majority of patients referred to otolaryngology clinics with rhinological symptoms. Although able to identify meatal obstruction by nasal polyps or oedematous mucosa, its role in UMSO is limited due to restricted views of middle meatus, little to no visualisation of the maxillary ostium, sinus contents, and consequent failure to demonstrate abnormalities deep to middle meatus [ 3 , 11 , 12 ].…”