Correlations between symptoms, nasal endoscopy computed tomography and surgical findings in patients with chronic rhinosinusitis.
BACKGROUND
Although chronic rhinosinusitis (CRS) is increasing in prevalence and incidence, its diagnosis and treatment still pose a challenge. The Task Force on rhinosinusitis (TFR) advocates the use of symptom based criteria. However, many otorhinolaryngologists depend on diagnostic nasal endoscopy and computed tomography (CT) of paranasal sinuses for diagnosis of CRS. Computed tomography has been extensively relied upon in confirming the presence of CRS, in assessing severity of disease, surgical planning and management decisions. Despite its widespread use, several studies have failed to correlate findings on CT with symptom severity.


OBJECTIVE
To determine the correlations between symptoms described at presentation, radiological findings, endoscopy and extensiveness of surgery.


METHODS
Longitudinal, prospective, analytical study conducted from August 2011 to August 2012 among 87 patients diagnosed as CRS according to the TFR criteria. Symptom, endoscopic, radiological and surgical scoring was done by using Lund and Mackay staging system. Pearson correlation coefficients between scores for symptoms, endoscopy, sinus CT and surgery was determined.


RESULTS
When overall symptom score was correlated with radiological score and endoscopy score, it was found to be statistically significant (p= <0.01). However, no significant relationship was found between Lund and Mackay symptom and surgery score.


CONCLUSIONS
The symptom criteria used by TFR for CRS diagnosis are not very specific for sinus disease. A detail assessment of the subjective and objective criteria (CT and endoscopy) is necessary for tailoring surgical plan but should not be relied upon for determining the extensiveness of surgical intervention.
Department of ENT and Head and Neck Surgery, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal.
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Pokharel
Department of Radiodiagnosis and Imaging,Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal.
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S
Karki
Department of ENT and Head and Neck Surgery, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal.
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BL
Shrestha
Department of ENT and Head and Neck Surgery, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal.
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I
Shrestha
Department of ENT and Head and Neck Surgery, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal.
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RC
Amatya
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012220:Rhinitis / Q000175:diagnosis* / Q000601:surgery; D012852:Sinusitis / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed