Nasal Endoscopic Findings Research Articles

Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes

To determine the primary diagnoses for which balloon catheter dilation (BCD) of sinus ostia is being employed in a profit-blind health care system, the Department of Defense. Retrospective chart review. From January 1, 2011 to December 31, 2013, 319 consecutive patient charts were reviewed for International Classification of Diseases, Ninth Edition (ICD-9) diagnoses, presence of chronic rhinosinusitis (CRS) defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), preoperative Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, postoperative outcomes, and complications. Of the 319 patients identified, 217 had sufficient documentation to be included. A CRS ICD-9 code was applied in 182 of 217 (83.9%) and recurrent acute rhinosinusitis in 12 of 217 (5.6%). Only 50.5% of CRS patient charts met criteria using EPOS guidelines. In contrast, 39.6% met the ICD-9 criteria for atypical facial pain. Patients with Lund-Mackay scores ≤ 4 were reviewed for number of sinuses dilated. Eighty-eight of 123 patients (71.5%) had sinuses dilated that were free from opacification/mucosal edema on preoperative imaging. Balloon dilation of sinus ostia has an expanding role in treating sinus disease. In the studied population, BCD is often utilized for alternate indications for which there is currently no evidence of efficacy. Future studies are needed to evaluate the efficacy of this technology in treating these alternate indications. 4. Laryngoscope, 127:544-549, 2017.

Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study

Background/AimsPatients with otorhinolaryngologic (ear, nose, and throat—ENT) symptoms attributed to gastroesophageal reflux disease (GERD) are usually treated with medication based on the findings of nasal endoscopy and laryngoscopy only. This study aims to determine sensitivity and specificity of symptoms, nasal endoscopy, and laryngoscopy for the diagnosis of GERD as compared to pH monitoring. MethodsWe studied 79 patients (mean age 53 years, 38 % males) in whom ENT symptoms were assumed to be secondary to GERD. All patients underwent a transnasal laryngoscopy by the ENT team and upper endoscopy and esophageal function tests by the surgical team. GERD was defined by a pathological pH monitoring. ResultsPathologic reflux by pH monitoring was documented in 36 of the 79 patients (46 %), with a mean DeMeester score of 44. In 25 of the 36 patients (69 %), distal and proximal reflux was present. Among patients with negative pH monitoring, one patient was diagnosed with achalasia. ENT symptom sensitivity for globus, hoarseness and throat clearing was respectively 11, 58, and 33 %; specificity was respectively 77, 42, and 58 %. Positive predictive value for nasal endoscopy and laryngoscopy was 46 %. Among patients with positive pH monitoring, 13 (36 %) had a hypotensive lower esophageal sphincter (p < 0.01) and 27 (34 %) had abnormal peristalsis (p < 0.01). ConclusionsIn conclusion, the results of this study showed that (a) ENT symptoms were unreliable for the diagnosis of GERD and (b) laryngoscopy had a low positive predictive value for the diagnosis of GERD. These data confirm the importance of esophageal manometry and pH monitoring in any patient with suspected ENT manifestations of GERD before starting empiric therapy with acid-reducing medications since pathologic reflux by pH monitoring was confirmed in less than half of the patients with suspected GERD.

Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report

In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4±2.2mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63±0.99 points to 3.88±0.92 points (postoperative 3months), 4.16±0.78 points (postoperative 6months), and 4.63±0.69 points (postoperative 1year). Six out of the eight patients were satisfied with the clinical outcome at 1year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB.

Aetiology, diagnosis and treatment of chronic rhinosinusitis: a study in a teaching hospital in Telangana

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic rhinosinusitis is one of the common problems in ENT Department which can be caused due to infections or anatomical blockage or allergy. We performed this study to assess the cause, clinical features and the effect of treatment on rhinosinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients of chronic sinusitis with symptoms persisting beyond three months, Nasal Endoscopic findings with Polyps/Discharge/edematous mucosa were included in the study. A detailed clinical history, with complete Ear, Nose, Throat, and Head and Neck examination, blood tests like complete blood picture, Blood sugar levels, ESR and Hepatitis profile. X ray of paranasal sinuses, (water’s view) and lateral view, Chest x-ray –PA View and CT scan of paranasal sinuses (axial and coronal section with 3mm cuts at OMC) was done for all patients. Diagnostic Nasal Endoscopic examination (DNE) for detection of polyps / discharge / edematous mucosa in middle meatus was also done for the patients where it was necessary. The patients were given medical or surgical treatment according to the symptom and followup was done for 3 months for all patients. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Over 75% of the patients had incidence of sinusitis in the age group of 16 – 45 years. The most common etiology was sinusitis caused by infections (26 – 44%) followed by anatomical obstruction (22 – 36%). Of the 22 anatomical obstruction the most common was Deviated nasal septum in 14 (62%) of the cases followed by 4 (19%) CB, 3 (15%) pradixical MT and 1 (4%) prominent aggernasi. The most common sign and symptom was headache and polypoidal changes observed in 36 patients each (60%), followed by nasal obstruction in 35 patients (50%). 12 (20%) of the patients were treated with polypectomy + FESS while 14 (23%) of them were treated with septoplasty + FESS. 34 (57%) were treated with only FESS.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Chronic sinusitis doesnot affect a particular age or sex and is more common among patietns with an upper respiratory tract infection. CT scan of the paranasal sinuses is the most useful tool in diagnosing the disease and FESS is the treatment of choice.

The Significance of Rhinologic Evaluation and Pretreatment for Patients Undergoing Two-Jaw Surgery Through Nasotracheal Intubation.

The aim of this study is to determine whether rhinologic preoperative evaluation and pretreatments reduce intranasal trauma and decrease postoperative complications, such as nasal obstruction and epistaxis, in patients undergoing 2-jaw surgery with nasotracheal intubation. This study included 360 patients with malocclusion (Class III) who underwent 2-jaw surgery under general anesthesia via nasotracheal intubation in our hospital from January to December 2013 and categorized into 3 groups. Nasotracheal intubation was performed according to the nasal cavity the patient was able to breathe comfortably (Group I). The site of nasotracheal intubation was decided by 1 rhinologic specialist who evaluated preoperative dental computed tomography (Group II). The site of nasotracheal intubation was decided upon nasal endoscopic findings, dental computed tomography evaluation, and rhinologic pretreatment (Group III).Group II and Group III showed less damage to the nasal mucosa compared with the nasal status of Group I. Upon comparing Group II and Group III, Group III showed better overall status of the nasal mucosa compared with Group II. Visual analogue scale scores for nasal obstruction were pretty similar for all groups on the first postoperative day. In Group III, the nasal mucosa, however, was improved to that of preoperative status on the third postoperative day.In conclusion, it may be useful to pre-evaluate the mucosal and anatomical status of the nasal cavity to select patients requiring rhinologic pretreatment and decide the site for nasotracheal intubation to minimize complications arising from nasotracheal intubation.

Evaluation of Sinonasal Diseases by Computed Tomography.

Computed Tomography (CT) plays an important diagnostic role in patients with sinonasal diseases and determines the treatment. The CT images clearly show fine structural architecture of bony anatomy thereby determining various anatomical variation, extent of disease and characterization of various inflammatory, benign and malignant sinonasal diseases. To evaluate sensitivity and specificity of CT in diagnosis of sinonasal diseases and to characterise the benign and malignant lesions with the help of various CT parameters. Also, to correlate findings of CT with histo-pathological and diagnostic nasal endoscopy/ Functional Endoscopic Sinus Surgery (FESS) findings. In this hospital based prospective study 175 patients with symptomatic sinonasal diseases were evaluated by clinical diagnosis and 16 slice Multi Detector Computed Tomography (MDCT). The details of findings of nasal endoscopy, Functional Endoscopic Sinus Surgery (FESS), histopathological examination and fungal culture were collected in all those cases where those investigations were done. All those findings were correlated with CT findings and statistical analysis was done by using Test statistics (sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy), Chi-Square test and Z-test for single proportions. Software used in the analysis was SPSS 17.0 version and graph pad prism 6.0 version and p < 0.05 was considered as statistically significant. CT diagnosis had higher sensitivity, specificity, PPV and NPV in diagnosing various sinonasal diseases in comparison to clinical diagnosis. On correlating CT diagnosis with final diagnosis, congenital conditions have 100% sensitivity and specificity. Chronic sinusitis has 98.3% sensitivity and 97.8% specificity. For fungal sinusitis the sensitivity was 60% and specificity was 99.3%. Polyps have sensitivity of 94.4% and specificity of 98.1%. Benign neoplasms have sensitivity of 90.9% and specificity of 99.2%, malignant neoplasms have sensitivity of 94.1% and specificity of 99.3%. The p-value in all instances was <0.05, i.e. <0.0001 indicating the significance of the findings. CT is the modality of choice in imaging the sinonasal region for evaluating various congenital, inflammatory, benign and malignant pathologies and associated complications thereby planning the further management of the patient. CT is the best modality of choice for evaluating the bone erosion or destruction. The potential pitfalls to differentiate on CT are fungal sinusitis and dense secretions.

Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies

BackgroundIn primary care and epidemiological studies of chronic rhinosinusitis (CRS), symptom-based diagnosis is common, yet limited, because endoscopic and radiological signs are not considered.ObjectivesTo evaluate the correlation between symptoms and...

Comparative Study of Diagnostic Nasal Endoscopy and CT Paranasal Sinuses in Diagnosing Chronic Rhinosinusitis.

Evaluation of the accuracy of objective diagnostic modalities for chronic rhinosinusitis and their comparison to each other to reach the correct diagnosis with minimum cost and highest accuracy. Prospective diagnostic cohort study. Academic medical center. Subjects more than 10years of age presenting for evaluation of chronic rhinosinusitis, not responding to 12weeks of medical treatment, suffering from at least 2 or more of the following symptoms- nasal obstruction, anterior and or posterior nasal discharge, headache or facial pains, and abnormalities of smell were prospectively studied. All selected patients were subjected to nasal endoscopy and CT paranasal sinuses. Endoscopic findings were scored according to Lund Kennedy scoring system. Sinus CT scans were scored with the Lund Mackay scoring system. The clinical diagnosis of CRS was determined on the basis of the published adult sinusitis guideline criteria and nasal endoscopic findings were compared with the diagnostic gold standard CT. A total of 100 patients were studied. Endoscopy was able to diagnose 87% as CRS based on Lund-Kennedy score ≥2. 93% patients could be labeled as CRS based on Lund-Mackey score ≥4. On correlating endoscopy and CT PNS it was found that sensitivity was 88.04%, specificity was 28.57%, PPV was 94.19%, NPV was 15.38%. Positive likelihood ratio of 1.23 and negative likelihood ratio of 0.42 was found p value was found to be 0.10565, thereby confirming that there is no significant difference in diagnosing CRS by either modality. The addition of nasal endoscopy helps reduce the use of CT, reducing costs and radiation exposure.

Nasal endoscopic evaluation and its impact on survival in patients with stage I/II extranodal natural killer/T-cell lymphoma, nasal type.

Endoscopic findings of extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, are heterogeneous, but not fully understood. The objective of this study was to evaluate the role of nasal endoscopic examination and its implications for treatment of stage I/II ENKTL. This retrospective study included 60 consecutive patients diagnosed with stage I/II ENKTL, nasal type, from 2000 to 2011. The endoscopic findings were classified into early (45%) and advanced (55%) lesions. Furthermore, the primary tumor extent assessed by endoscopy was significantly correlated with the radiologic imaging (p < 0.001). The results of univariate analysis showed that the patients with advanced lesions had worse overall survival (p = 0.004) and disease-free survival (p = 0.001) than those with early lesions. In multivariate analysis, advanced lesions on nasal endoscopy was an independent prognostic factor (p = 0.024; hazard ratio 5.29; 95% confidence interval, 1.25-22.39). We found that nasal endoscopic findings were important prognostic factors in stage I/II ENKTL, nasal type, suggesting that comprehensive endoscopic evaluation of primary tumor should be performed in this setting.

Clinical Effectiveness of Monocanalicular Silicone Intubation for Congenital Nasolacrimal Duct Obstruction Under Nasal Endoscopic Visualization of the Terminal End of the Obstructed Nasolacrimal Duct.

To evaluate the cause of nasolacrimal duct obstruction through confirmation by nasal endoscopic findings of Hasner's valve and to report the success rate of monocanalicular silicone intubation (MCI) for the management of congenital nasolacrimal duct obstruction (CNLDO). Seventy-seven eyes of 56 patients with CNLDO underwent MCI under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct at the Korea University Ansan Hospital and Guro Hospital from October 2008 to March 2013. The following demographic information was analyzed: age, sex, endoscopic findings of Hasner's valve during operation, complications, and outcomes. The main outcome measures were disappearance of epiphora symptoms beginning the first 2 months after removal of the silicone tube. The silicone tube was removed under topical anesthesia in the office between 2 and 3 months, postoperatively. The mean (± SD) age of the study population was 29.8 (± 26.9) months (range: 6 months to 12 years). Under nasal endoscopic view, 45 ducts (58.4%) had a thin membranous obstruction or had a simple stenotic opening of Hasner's valve. Seven ducts (9.1%) had thick obstructing membranes with probe passage under the lateral nasal mucosa. Twenty-three ducts (29.9%) showed the probe tip protruding through balloon-like nasal mucosa. Two ducts (2.6%) appeared to have probe protrusion through a stretchable valve. The overall success rate was 89.6% (69/77). The incidence of tube prolapse and tube loss was 18.2% (14 eyes) and 13.0% (10 eyes), respectively. No other complications were observed. Monocanalicular silicone intubation under nasal endoscopic visualization of the terminal end of the obstructed nasolacrimal duct can be an effective procedure for the management of CNLDO.

The application of an ultrasonic bone aspirator for septoturbinoplasty.

The objectives of this study were to introduce the use of an ultrasonic bone aspirator (UBA; SONOPET [Mutoh Co, Ltd, Tokyo, Japan]) for septoturbinoplasty and to evaluate the efficacy and usefulness of this surgical procedure. This was a retrospective chart review. This study was performed at a university medical center. Of the 53 patients who underwent septoturbinoplasty from July to October 2013, 30 were operated on using a UBA and were enrolled in this study. Patients were followed for more than 6 months after surgery. Patterns of septal deviation and surgical results and complications were investigated by paranasal sinus computed tomography scans, nasal endoscopy, and acoustic rhinometry. Improvement of symptoms was measured using the Nasal Obstruction Symptom Evaluation scale. Patterns of bony septal deviation were classified as follows: localized septal bony spur or crest (n = 7), basal bony septal deviation (n = 9), posterior bony septal deviation (n = 8), bony spur with basal part deviation (n = 5), and basal and posterior bony septal deviation (n = 1).Twenty-six patients underwent septoplasty with bilateral inferior turbinate reduction surgery using either a microdebrider (n = 10) or a microdebrider with UBA (n = 16). Four patients underwent septoplasty with unilateral turbinate reduction surgery using a microdebrider and UBA. Based on nasal endoscopic findings after surgery, 24 patients had a straight septum, whereas 6 exhibited minimal remaining curvature. Subjective symptoms of nasal obstruction evaluated using the visual analog scale and the Nasal Obstruction Symptom Evaluation scale were improved in all patients. Surgery using a UBA increased minimal cross-sectional area and nasal volume change in patients. There were no significant complications related to UBA use such as saddle nose, bleeding, or septal perforation. Application of a UBA for septo-turbinate surgery is an easy, safe, and effective method that reduces the occurrence of common complications, such as septal perforation, delayed healing, infection, and bleeding. In addition, the UBA produces minimal thermal and mechanical injury to surrounding tissue and enables precise and incremental bone removal with continuous irrigation and suction. This tool allows for easy sculpting and reduction of bony architecture of the nasal cavity.

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery.

Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. This study is a retrospective review of a subgroup of patients studied in the clinical trial "Rhinological Outcomes in Endonasal Pituitary Surgery" (clinical trial no. NCT01504399, clinicaltrials.gov ). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence. Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.

Impact of educational intervention on the interrater agreement of nasal endoscopy interpretation.

Nasal endoscopy is integral to the evaluation of sinonasal disorders. However, prior studies have shown significant variability in the interrater agreement of nasal endoscopy interpretation among practicing rhinologists. The objective of the current study is to evaluate the interrater agreement of nasal endoscopy among otolaryngology residents from a single training program at baseline and following an educational intervention. Eleven otolaryngology residents completed nasal endoscopy grading forms for eight digitally recorded nasal endoscopic examinations. An instructional lecture reviewing nasal endoscopy interpretation was subsequently provided. The residents then completed grading forms for eight different nasal endoscopic examinations. Interrater agreement among residents for the pre- and postlecture videos was calculated using the unweighted Fleiss' kappa (Kf) statistic and intraclass correlation agreement (ICC). Interrater agreement improved from a baseline level of fair (Kf range 0.268-0.383) to a posteducational level of moderate (Kf range 0.401-0.547) for nasal endoscopy findings of middle meatus mucosa, middle turbinate mucosa, middle meatus discharge, sphenoethmoid recess mucosa, sphenoethmoid recess discharge, and atypical lesions (ICC, P < 0.001). The baseline level of agreement for evaluation of nasal septum deviation was poor/fair and did not improve following educational intervention. This study demonstrates a limited baseline level of interrater agreement of nasal endoscopy interpretation among otolaryngology residents. The interrater agreement for the majority of the characteristics that were evaluated improved after educational intervention. Further study is needed to improve nasal endoscopy interpretation. N/A.

A new clinical scoring system for adenoid hypertrophy in children.

Chronic nasal obstruction due to adenoid hypertrophy is a very common disorder. Although the clinical assessment of adenoid hypertrophy is essential, its real value in young children is difficult to evaluate. The purpose of this prospective study was to validate a simple clinical score to predict the severity of adenoid obstruction and to evaluate the relationship between this method of clinical scoring with radiography and nasopharyngeal endoscopy. Ninety symptomatic children were enrolled into this study. The clinical score included difficulty of breathing during sleep, apnea, and snoring. We investigated the relationship between clinical scoring, nasal endoscopy, and radiographic findings. The clinical score correlated very well with endoscopic findings (P<0.000), but the correlation between the clinical score and radiologic findings (P>0.05) and endoscopic findings and imaging (P>0.05) was weak. Clinical findings could be used to select children for adenoidectomy, especially when endoscopic examination is not available or cannot be performed.

Nasal endoscopy: new tools and technology for accurate assessment.

In this chapter the technique of nasal endoscopy is discussed. Standardized reporting of nasal endoscopy findings is essential in order to allow communication between different surgeons, speech therapists and endoscopists. Representative videos are provided for the normal examination, for coronal and sagittal velopharyngeal closure patterns, as well as for other anatomical variants of interest. Recommendations for tailoring surgical therapy based on the nasopharyngeal closure pattern are given, although the experience of the surgeon is an important factor for success of any surgical procedure for velopharyngeal insufficiency. Limitations and new frontiers of the technique of nasal endoscopy are also outlined.

Treatment of aspirin exacerbated respiratory disease with a low salicylate diet: a pilot crossover study.

Aspirin exacerbated respiratory disease (AERD) is comprised of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Treatment of this condition is challenging and may include topical/systemic steroids, endoscopic sinus surgery, and/or aspirin desensitization. A prospective crossover pilot study (n = 10) was conducted in which patients were randomized into either of 2 groups with 6 weeks of regular diet (R) or 6 weeks of a low salicylate diet (LS). The study was conducted in a tertiary otolaryngology clinic. Patients with AERD were enrolled in the study. Subjective (Sino-nasal Outcome Test-22 [SNOT-22], Nasal Sinus Symptom Scale [NSSS], and the Asthma Control Questionnaire-7 [ACQ-7]) and objective outcome instruments (Peri-Operative Sinus Evaluation [POSE] and Lund-Kennedy Endoscopic Score [LKES]) were used to evaluate patients at baseline, 6 weeks (at crossover), and 12 weeks. Wilcoxon rank sum tests demonstrated that patients on the low salicylate diet had improved scores compared to their regular diet when evaluated by 4 of the 5 outcome measures (SNOT-22 pLS = 0.0059, NSSS pLS = 0.0195, LKES pLS = 0.0039, POSE pLS = 0.005). Results of the pilot study indicate that implementation of a low salicylate diet improves the nasal symptoms and nasal endoscopy findings of individuals with AERD. Further research is required to support these findings.

Interrelation between Symptoms and Nasal Endoscopic Findings in the Diagnosis of Chronic Rhinosinusitis

Objectives: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) criteria are the most commonly used criteria in the diagnosis of chronic rhinosinusitis (CRS) in Korea. Symptom-based EP3OS criteria are used in epidemiological studies, but its reliability and the best composition of criteria have not been thoroughly examined. Therefore, we aimed to verify its reliability and search the best combination of criteria to diagnose CRS in a large scale. Methods: The 2009 and 2010 data (15,445 people) on Korean National Health &amp; Nutrition Examination Survey symptom questionnaire and nasal endoscopic findings were analyzed. EP3OS criteria composed of major and minor symptoms were used to define symptom-based CRS. Either mucopurulent rhinorrhea from middle meatus or nasal polyp was the definition of endoscopy-based CRS. The correlation between these definitions of CRS and the relative importance of symptoms, and the best combination of symptoms were analyzed. Results: The symptom-based definition of CRS showed statistically significant correlation with the endoscopy-based definition of CRS (Pearson r =0.120, P &lt; .001). As to the correlation between symptoms and positive endoscopic finding, hyposmia or anosmia was the most correlated symptom (Pearson r = 0.134, P &lt; .001). The most reliable symptom-based definition of CRS was +one of major symptoms + hyposmia or anosmia. Conclusions: Because the symptom-based definition didn’t show strong correlation with the endoscopy-based definition, the combination of both definitions is essential in the diagnosis of CRS. If symptom-based definition is used, one of major symptoms + hyposmia or anosmia is the most reliable criterion in the diagnosis of CRS.

Method of the diagnosis of adenoid hypertrophy for physicians: adenoid-nasopharynx ratio.

We aimed to describe the feasibility of a prediction of adenoid hypertrophy by pediatricians for diagnostic accuracy of nasopharyngeal x-ray in a pediatric unit. Forty-six patients with a history of probable adenoid hypertrophy between January 2013 and August 2013 were included in the study. Participants were excluded from the study if they had previous adenoidectomy; anatomic anomaly in the nose, palate, or nasopharynx; and acute infection. Nasal endoscopy was performed and evaluated adenoid size (choanal obstruction ratio) in all patients by an otorhinolaryngologist who was blinded to the information of other data. Lateral nasopharyngeal x-ray graphs of all patients were evaluated by pediatricians with adenoid-nasopharynx (A-N) ratio, who were blinded to the information of other data. The A-N ratio was calculated by Fujioka method. The A-N ratio of each patient was compared with the choanal obstruction ratio that was determined in the nasal endoscopic examination. Spearman correlation test was used for statistical analysis, and P < 0.05 was described as significant. Forty-six patients were included in this study. The study sample consisted of 25 male (54.3%) and 21 female (45.7%) patients. The mean age of the patients was 6.17 years (range, 2-14 y). In the nasal endoscopic examination, the mean (SD) choanal obstruction ratio was 64.6% (19.5%) (range, 12.5%-90%). Mean (SD) A-N ratio was found to be 16.7 (14.4). The A-N ratio correlated with nasal endoscopic examination findings (r = 0.334, P = 0.023) CONCLUSIONS: The A-N ratio was found to be a useful, tolerable, and confident diagnostic method in pediatric patients for adenoid hypertrophy. Pediatricians can confidently use this method for decision after follow-up or operation.

Endoscopy findings affect subjective smell rehabilitation in post-laryngectomy patients using the nasal airflow-inducing manoeuvre.

To evaluate the characteristics of post-laryngectomy patients, including nasal endoscopy findings, that affect subjective smell improvement in the post-surgical period. Thirty patients who had undergone total laryngectomy participated in at least three sessions of a smell rehabilitation programme involving the nasal airflow-inducing manoeuvre, under the supervision of a speech-language pathologist. Patient characteristics and nasal endoscopy findings were evaluated. Participants experienced a mean improvement in sense of smell of 61 per cent (p<0.001) and a significant improvement in appetite (p=0.002). Male patients and patients with a nasal discharge had a significantly better outcome. The nasal airflow-inducing manoeuvre is an effective method for improving smell perception and appetite in laryngectomy patients. There was no relationship between nasal endoscopy findings and outcome of the nasal airflow-inducing manoeuvre rehabilitation programme in our case series.

Endoscopic, radiological, and symptom correlation of olfactory dysfunction in pre- and postsurgical patients of chronic rhinosinusitis.

The aim of the present study was to correlate olfactory dysfunction determined with psychophysical testing with nasal endoscopy, computed tomography (CT) scan, and patient's self-assessed olfactory deficit in patients of chronic rhinosinusitis (CRS) before and after sinus surgery. It was a prospective cohort study comprising of a total of 40 consecutive patients of CRS. All of them were given Connecticut Chemosensory Clinical Research Center Test for olfactory evaluation, nasal endoscopy, CT scan, and a graded questionnaire for perceived olfactory ability preoperatively on the same day after failing maximal medical management for 3 weeks. All investigations except CT scan were repeated 3 months postsinus surgery. For metrics, Visual Analog Scale (VAS) score, Lund Kennedy nasal endoscopy score, and Lund MacKay CT score were used. Spearman's correlation coefficients were determined between olfactory scores and endoscopic, CT, and VAS scores. Significant positive correlation was found between subjective VAS scores and composite odor scores both preoperatively (r = 0.89, P < 0.001) and 3 months postoperatively (r = 0.54, P < 0.001). Significant negative correlation was established between olfactory scores and CT (r = -0.71, P < 0.001). With nasal endoscopy also, the correlation results of odor scores were significant (r = -0.39, P = 0.01 in preoperative period and r = -0.47, P = 0.002 in postoperative period). Hence, it could be concluded that severity of olfactory disturbance determined by olfactory tests correlates well with nasal endoscopic findings, presence of CT opacification, and the patient's self-perceived olfactory insufficiency in CRS both before and after sinus surgery and can guide us well to determining the olfactory burden.