The diagnosis of inflammatory sinonasal disease.

A prospective study was carried out on 25 consecutive patients referred to an outpatient clinic at The Royal National Throat, Nose and Ear Hospital, with a medical letter suggestive of sinusitis, to test the hypothesis that the diagnosis of inflammatory sinus disease could be made simply and accurately by employing systematic nasal endoscopy and a series of plain sinus X-rays. The study compared the diagnostic yields of the history, rigid nasal endoscopy and plain sinus films with computed tomography. All the investigations were performed on the same day. The interobserver variability between consultant ENT surgeon, senior registrar and registrar were compared. With heightened concern over the radiation exposure patients are receiving for medical investigations, the radiation exposure was determined for a selected group of patients. This study demonstrated that in the diagnosis of inflammatory sinonasal disease the clinical assessment correlated with the CT findings in over 90 per cent of cases. This accuracy was dependent on the experience of the clinician in using rigid nasal endoscopy. Interobserver variability ranged from 71 to 90.4 per cent in the correct diagnosis of underlying sinus disease. Close agreement was seen with the interpretation of CT scans. The concordance rate between plain films and CT scans was 87 per cent when reported by a consultant radiologist. This is in close agreement with previously reported studies. The average radiation exposure of coronal CT scanning was 218 times the dose for plain sinus X-rays.

Errors in the assessment of tympanic membrane perforations.

It is commonly stated that operative closure of large perforations of the tympanic membrane is less successful than closure of small perforations. Few authors mention the exact size of the perforations studied, and fewer still give their method of measuring perforations. We describe a photographic method of assessing the size of perforations relative to the total drumhead, measuring them with a computerized digitizing pad. Thirteen temporal bones were selected at random. Perforations of different sizes, shapes and at different sites were fashioned in the tympanic membranes. These were assessed by clinicians of all grades, who were asked to draw the perforations and give estimates of the perforation size as a percentage of the total drumhead. Visual estimates and drawings were compared with a photographic objective method. Gross errors (some in excess of 100%) were apparent in both estimates and drawings. There was a highly significant statistical difference between the objective method and visual estimates and drawings (P < 0.001). Greater clinical experience was not correlated with better performance in estimating the size of perforations.