title: Nasal endoscopy is recommended for diagnosing adults with chronic rhinosinusitis.
abstract: OBJECTIVE
  To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library.
  
  
  METHODS
  A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data.
  
  
  RESULTS
  Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%.
  
  
  CONCLUSIONS
  Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Annemarie M H
authors.initials: AM
authors.lastname: Wuister
authors.forename: Namiko A
authors.initials: NA
authors.lastname: Goto
authors.forename: E J
authors.initials: EJ
authors.lastname: Oostveen
authors.forename: Werner U
authors.initials: WU
authors.lastname: de Jong
authors.forename: Eline S
authors.initials: ES
authors.lastname: van der Valk
authors.forename: Nina M
authors.initials: NM
authors.lastname: Kaper
authors.forename: Mark C J
authors.initials: MC
authors.lastname: Aarts
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009666:Nose; D017410:Practice Guidelines as Topic; D012220:Rhinitis / Q000175:diagnosis*; D012852:Sinusitis / Q000175:diagnosis*
keywords: chronic rhinosinusitis; diagnosis; evidence based medicine; nasal endoscopy