Comparative Study of Ultrasonography and Computed Tomography in the Diagnosis of Nasal Bone Fractures

The objective of this study was to compare the diagnostic accuracy of ultrasonography and computed tomography (CT) in the diagnosis of nasal bone fractures (NBFs) and to assess their clinical utility in the context of current evidence-based recommendations.

This prospective analytical study was conducted in the Department of Otorhinolaryngology between January 2021 and December 2022, encompassing 126 patients with clinically diagnosed NBFs who provided informed written consent. Ultrasonographic and CT imaging were used to detect and characterize fractures. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ultrasonography and CT in identifying NBFs were calculated with 95% confidence intervals (CIs).

Among 126 patients (mean age: 38.4 years; 90.5% male), clinical examination identified NBFs in all cases. Ultrasonography detected 121 fractures (accuracy: 96.0%), while CT detected 125 fractures (accuracy: 99.2%). Sensitivity of ultrasonography was 88.57% (95% CI: 83.2-92.5%) compared to the CT sensitivity of 97.3% (95% CI: 94.8-98.9%). Both modalities demonstrated 100% specificity. McNemar's test demonstrated a statistically significant difference in sensitivity between CT and ultrasonography (p = 0.008). CT showed superior sensitivity in detecting undisplaced fractures (35 vs. 31 cases, p = 0.047), with no significant difference for displaced or comminuted fractures (p > 0.05).

While CT demonstrates superior sensitivity, particularly for undisplaced NBFs, ultrasonography offers a valuable non-ionizing alternative for initial fracture assessment in appropriate clinical contexts. Both modalities demonstrated high sensitivity for displaced fractures. However, the choice of imaging should balance the superior accuracy of CT against the safety and accessibility of USG, with awareness of operator dependency. Further prospective studies with multi-center participation and varied operator experience levels are warranted to determine optimal imaging strategies.