Effectiveness of Office Nasal Endoscopy as Preliminary Diagnostic Tool: A Comparative Study versus CT Sinus Imaging

Objectives: To determine diagnostic effectiveness of office fiberoptic nasal endoscopy as preliminary examination tool during outpatient clinic examinations of patients with chronic rhinosinusitis (CRS). Patients & Methods: One hundred CRS UAE patients (Group A) and another 100 Egyptian patients (Group B). All patients were evaluated for impact of CRS on their quality of life (QOL) using the Sino-Nasal Outcome Test (SNOT-22 test) followed by endoscopic evaluation of the extent of the disease using Lund & Kennedy score (LKS) and CT scan of paranasal sinuses interpreted according to Lund-Mackay scale (LMS). All patients received bilateral sinonasal irrigation using ceftriaxone sodium 1 gm dissolved in 200 ml normal saline. Nasal irrigation using the same fluid was used twice daily for 6 weeks and reevaluated. Patients with persistent manifestations were prepared for functional endoscopic sinus surgery (FESS) and were re-evaluated 6 weeks after surgery. Patients' response to treatment as judged by SNOT-22 test evaluated at end of 6 weeks was used to verify outcome of preliminary investigation modality. Results: Baseline SNOT-22 score of group A was significantly higher than group B. SNOT22 scores determined at end of treatment were significantly lower in both groups compared to their respective baseline scores. SNOT-22 score determined at end of treatment was significantly higher in group B compared to group A. Frequency of patients had secretions and mucosal edema in group A was significantly higher than in group B with significantly higher scoring and significantly higher total scoring in group A than in group B. Baseline SNOT-22 in both groups showed positive significant correlation with LKS and LMS scoring. However, the correlation was more significant between baseline SNOT-22 and LKS scoring than with LMS scoring. Cumulative risk for CRS of imposing high impact on patients' QOL was higher with high LKS scoring for endoscopic findings than with high LMS scoring for CT findings. Conclusion: Office nasal endoscopy is effective diagnostic modality for patients with CRS and could spare the need for CT for preliminary evaluation. For these advantages, office nasal endoscopy is recommended as routine examination tool for diagnosis and follow-up of patients presenting with manifestations of CRS. [Mohamed F. Shindy and Mohamed Ali El-Sayed. Effectiveness of Office Nasal Endoscopy as Preliminary Diagnostic Tool: A Comparative Study versus CT Sinus Imaging. J Am Sci 2015;11(8):57-63]. (ISSN: 15451003). http://www.jofamericanscience.org. 9