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May chronic rhinosinusitis in children be diagnosed by clinical symptoms?
Gualtiero Leo1, Cristoforo Incorvaia2, Alessandro Cazzavillan3
1Pediatric Allergy and Respiratory Pathophysiology Unit, Vittore Buzzi Children's Hospital, Istituti Clinici di Perfezionamento, Milan, Italy.
Insights
A combination of symptoms, particularly rhinorrhea, can help diagnose chronic rhinosinusitis (CRS) in children. This symptom assessment can reduce the need for invasive nasal fibroendoscopy (NF) or imaging.
Area of Science:
- Pediatric Otolaryngology
- Allergy and Immunology
Background:
- Chronic rhinosinusitis (CRS) is prevalent in children but frequently underdiagnosed due to subtle, non-specific symptoms.
- Current diagnostic standards, nasal fibroendoscopy (NF) and imaging, are not always accessible to clinicians.
Purpose of the Study:
- To evaluate if symptom combinations can reliably diagnose pediatric CRS, correlating with NF confirmation.
- To establish a clinical diagnostic pathway for CRS in children, minimizing reliance on advanced tools.
Main Methods:
- A cohort of 275 children with clinically diagnosed CRS was studied.
- Symptoms including nasal obstruction, discharge, cough, facial pain, and halitosis were analyzed using logistic regression and ROC curves.
- Diagnosis was confirmed by nasal fibroendoscopy (NF) in 228 children; 47 served as controls.
Main Results:
- Rhinorrhea emerged as the most significant predictor of CRS.
- The presence of three symptoms increased CRS probability to 60-91% (with rhinorrhea).
- Four or five symptoms yielded a CRS probability exceeding 93% and nearly 100%, respectively.
Conclusions:
- Initial symptom assessment, especially the presence of rhinorrhea, can identify children with a high likelihood of CRS.
- This approach may reduce the necessity for nasal fibroendoscopy (NF) or imaging in diagnosing pediatric CRS.
Objectives:
Chronic rhinosinusitis (CRS) is a common disease in childhood but is often underdiagnosed because the symptoms are subtle and similar to other nasal pathologies. No clinical symptom is pathognomonic, and consensus documents suggest nasal fibroendoscopy (NF) or imaging criteria (computed tomography, magnetic resonance imaging) as the gold standards for diagnosis of CRS. However, considering the frequent unavailability of such tools to physicians, we designed this study to evaluate whether combinations of symptoms may achieve a clinical diagnosis of CRS in children as confirmed by NF.
Methods:
The study population consisted of 275 children with a clinical diagnosis of CRS, in 228 of whom diagnosis of CRS was confirmed by NF, while in 47 diagnosis was not confirmed by NF and they served as the control group. The symptoms considered were nasal obstruction, nasal discharge, cough, facial pain, and halitosis, using for statistical analysis multivariate logistic regression, Wald tests, and receiver operating characteristic (ROC) curve.
Results:
The multivariate logistic regression for CRS symptoms indicated rhinorrea as the strongest predictor of CRS. With three symptoms the probability of CRS was from 60% to 75% without rhinorrea and 77-91% in the presence of this symptom, with four symptoms the probability was over 93%, and with all the five symptoms the probability of having CRS was virtually 100%.
Conclusions:
These findings suggest that an initial symptoms assessment may help to recognize children with a high probability of CRS, thus reducing the need of NF or imaging techniques.
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