Radiologic correlates of symptom-based diagnostic criteria for chronic rhinosinusitis

• Published in: Otolaryngology-head and neck surgery Vol. 128; no. 4; p. 489
• Main Authors: Hwang, Peter H, Irwin, Sande B, Griest, Susan E, Caro, James E, Nesbit, Gary M
• Format: Journal Article
• Language: English
• Published: England 01.04.2003
• Subjects: Chronic Disease; Female; Humans; Male; Middle Aged; Pilot Projects; Predictive Value of Tests; Prospective Studies; Rhinitis - complications; Rhinitis - diagnosis; Rhinitis - diagnostic imaging; Sensitivity and Specificity; Sinusitis - complications; Sinusitis - diagnosis; Sinusitis - diagnostic imaging; Surveys and Questionnaires; Tomography, X-Ray Computed
• ISSN: 0194-5998
• DOI: 10.1016/S0194-59980223295-7

In 1997, the Task Force on Rhinosinusitis (TFR) set forth symptom-based diagnostic guidelines for chronic rhinosinusitis (CRS). In the present study, we examined radiologic correlates of the TFR diagnostic criteria for rhinosinusitis. One hundred twenty-five consecutive patients undergoing computed tomography (CT) scans of the sinuses were studied at Oregon Health and Science University. Patients were evaluated prospectively with a questionnaire based on the TFR criteria, and their CT scans were graded according to the Lund-Mackay scoring system. Of the 125 patients, 115 met the symptom criteria for CRS. However, 40 of 115 had negative scans (Lund-McKay score, 0) despite meeting the diagnostic criteria for rhinosinusitis. Of 115, 75 had positive scans (Lund-McKay score, >1). Of the 10 patients who had negative diagnoses for rhinosinusitis, 9 had a positive CT scan. The Kappa coefficient was -0.103 (+/-95% confidence interval, -0.201 to -0.004), indicating poor agreement between CRS positivity and CT positivity. The sensitivity of TFR criteria for detecting a positive scan was 89%, but the specificity was poor at only 2%. Based on these pilot data, it appears that the specificity and predictive value of the current TFR criteria may not be adequate to serve as a diagnostic standard for rhinosinusitis. Additional validating data may provide guidance for improving the sensitivity and specificity of symptom-based diagnostic instruments for rhinosinusitis.