Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases

Sinonasal endoscopy is an essential part of the rhinologic examination performed by otolaryngologists in the evaluation of sinonasal disease. The use of the endoscopes has been popularized with the advent of endoscopic sinus surgery. To evaluate the role of nasal endoscopy as primary examination in the early and accurate diagnosis of sinonasal diseases in comparison to other diagnostic tools in rhinology. A retrospective and prospective study was carried out on 200 patients with clinical evidence of sinonasal diseases. They were evaluated with anterior rhinoscopy, nasal endoscopy and CT paranasal sinus. The level of agreement between anterior rhinoscopy and nasal endoscopy was substantial for deviated nasal septum, inferior turbinate hypertrophy and polyp (0.735, 0.712 and 0.709, respectively), but moderate for middle turbinate hypertrophy (0.418). The results of endoscopy and CT comparison among 80 patients, whose symptoms warranted CT, indicated that although for most of the findings, there was almost perfect to substantial level of agreement between the results of the two methods, five patients had normal CT imaging report, while they demonstrated early polyps during endoscopic evaluation. Also, CT missed 4 cases of deviated nasal septum. Diagnostic nasal endoscopy proved a better technique to detect various sinonasal pathologies as well as anatomical variations, which are otherwise missed on Computed Tomography or inaccessible on anterior rhinoscopy especially in the key area comprising the ostiomeatal complex. We reinforce the fact that it should be viewed as an essential part of a complete examination of the nose and sinuses.