Side-Specific Concordance Between Nasal Endoscopy and Computed Tomography Severity in Pediatric Chronic Rhinosinusitis.
Nasal endoscopy scores correlate strongly with computed tomography severity on a side-by-side basis in children
Side-Specific Concordance Between Nasal Endoscopy and Computed Tomography Severity in Pediatric Chronic Rhinosinusitis.
The European Position Paper on Rhinosinusitis (EPOS) diagnoses chronic rhinosinusitis (chronic rhinosinusitis) from symptoms with nasal endoscopy and/or computed tomography (computed tomography), but how closely a graded endoscopic score reflects computed tomography severity in children-and whether it does so side-specifically-is poorly defined.
Retrospective analysis of 73 children (33 girls, 40 boys; aged 5-17 years) treated surgically for chronic rhinosinusitis after failed medical therapy.
endoscopy ranked side severity well, closely tracking computed tomography findings side by side
Bland-Altman analysis showed a systematic bias (endoscopy -10.6% relative to computed tomography) and wide 95% limits of agreement (-32.6% to +11.4%), indicating that endoscopy ranks disease severity well but is not quantitatively interchangeable with computed tomography at the individual level.
Dichotomized side-specific agreement was more modest and improved as the computed tomography threshold for a diseased side was raised (κ 0.21-0.50).
Children with polyps had higher Lund-Mackay scale than those without ( p = 0.007).
Only the agger nasi cell correlated with ipsilateral frontal disease (adjusted p = 0.017).
A graded nasal endoscopic score is a strong ordinal correlate of computed tomography severity in pediatric chronic rhinosinusitis, but Bland-Altman analysis shows it cannot quantitatively substitute for computed tomography at the individual level.
Endoscopy is therefore best used as a non-ionizing surrogate to grade severity, monitor disease and select which children need computed tomography, while computed tomography remains necessary for surgical planning.
Because the cohort comprised children with advanced chronic rhinosinusitis, generalizability to milder disease requires confirmation.