Nasal obstruction has multiple causes requiring specialist endoscopy for diagnosis. A rule-based expert system (RB-ES), which applies five 'if-then' rules based on nasal features, may help replicate ENT decision-making in settings with limited access. Objectives & Hypotheses: This study evaluated RB-ES in diagnosing allergic rhinitis (AR), chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps, and deviated nasal septum (DNS). Primary outcomes were sensitivity and specificity; secondary outcome was agreement with ENT specialists. Prospective cohort study Methods: Seventy-one participants (65 patients, 6 controls) underwent pre- and post-decongestion endoscopy. Four ENT specialists provided diagnoses. RB-ES performance was compared against confirmed clinical diagnoses. RB-ES showed no detectable significant sensitivity differences from ENT specialists (all p > 0.05). Sensitivity was highest for CRSwNP; specificity remained high overall. RB-ES matched specialist performance in CRSwNP diagnosis. Dataset expansion and AI integration are recommended for further validation.
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