Diagnostic accuracy of clinical visual assessment using endoscopic images for nasal cavity mass lesions.

Objectives: Discrimination of nasal cavity lesions using nasal endoscopy is challenging because of the differences in clinical manifestations and treatment strategies. We aimed to investigate the diagnostic accuracy of clinical visual assessment (CVA) of nasal cavity masses using endoscopic images and determine whether there is a difference according to pathologic class and the examiners' experience. Methods: We collected pathologically confirmed endoscopic images of normal findings, nasal polyp (NP), benign tumor, and malignant tumor (each class contained 100 images) randomly selected. Eighteen otolaryngologists, including six junior residents, six senior residents, and six board-certified rhinologists classified the test set images into four classes of lesions by CVA. Diagnostic performance according to the pathologic class and the examiner's experience level was evaluated based on overall accuracy, F1-score, confusion matrix, and area under the receiver operating characteristic curve (AUC). Results: Diagnostic performance was significantly different according to the pathological class of nasal cavity mass lesions with the overall accuracy reported high in the order of normal, NP, benign tumor, and malignant tumor (0.926 ± 0.100; 0.819 ± 0.135; 0.580 ± 0.112; 0.478 ± 0.187, respectively), F1 score (0.937 ± 0.076; 0.730 ± 0.093; 0.549 ± 0.080; 0.554 ± 0.146, respectively) and AUC value (0.96 ± 0.06; 0.84 ± 0.07; 0.70 ± 0.05; 0.71 ± 0.08, respectively). The expert rhinologist group achieved higher overall accuracy than the resident group (0.756 ± 0.157 vs. 0.680 ± 0.239, p < .05). Conclusion: CVA for nasal cavity mass was highly dependent on the pathologic class and examiner's experience. The overall accuracy was reliably high for normal findings, but low in classifying benign and malignant tumors. Differential diagnosis of lesions solely based on nasal endoscopic evaluation is challenging. Therefore, clinicians should consider further clinical evaluation for suspicious cases.

Sinus balloon dilators: one surgeon's experience and proposed indications for their use.

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

[Quality of life assessment with the use of the SF-36 in patients with nasal polyposis: correlations with clinical and laboratory findings]. / Nazal polipozisli hastalarda yasam kalitesinin SF-36 ile ölçülmesi, klinik ve laboratuvar verilerle degerlendirilmesi.

OBJECTIVES: We evaluated the quality of life of patients with nasal polyposis and sought correlations between clinical and laboratory parameters and quality of life. PATIENTS AND METHODS: Thirty-two patients (8 females, 24 males; mean age 43 years; range 15 to 68 years) with nasal polyposis were evaluated by history, physical examination, endoscopy, computed tomography (CT), nasal smear, and skin prick tests. Quality of life was assessed using the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: The mean CT score showed a weak correlation with symptom and endoscopic scores (p<0.05), whereas the latter two scores were not correlated. All the SF-36 scales were adversely influenced, particularly including the scores for role limitation caused by emotional problems, general perception of health, vitality, and role limitation caused by physical problems. An inverse correlation was found between increasing age and complaints of pain (p<0.05). Symptom scores were correlated only with role limitation caused by emotional problems (p<0.05). Duration of nasal symptoms was correlated with increased scores for role limitation caused by physical problems, mental health, social functioning, and pain (p<0.05). Computed tomography stage was correlated with role limitation caused by emotional problems, pain, and social functioning, whereas CT scores showed correlation only with pain (p<0.05). The presence of asthma adversely influenced general perception of health scores (p<0.05). CONCLUSION: Nasal polyposis adversely affects the quality of life of patients, the extent of deterioration being more prominent in certain subscales.