Diagnostic value of black spots and granular changes in pretreatment endoscopic evaluation of chronic epipharyngitis

This study aimed to determine whether incorporating black spots and granular changes observed under band‑limited light endoscopy (OE‑mode 1) improves non‑invasive pretreatment diagnostic scoring for chronic epipharyngitis. Bleeding during abrasion is an important diagnostic indicator but cannot be assessed at the initial visit because it requires performing epipharyngeal abrasive therapy (EAT). Therefore, we examined whether pretreatment scoring based solely on baseline endoscopic findings can reliably estimate disease status.

We retrospectively analyzed 200 patients who underwent routine epipharyngeal endoscopy. Two pretreatment scoring schemes were developed: Plan A (replacement of bleeding with black spots) and Plan B (addition of black spots and granular changes). Their diagnostic performance and inter‑rater reliability were compared with the conventional score using standard statistical methods. Associations between endoscopic findings and disease‑related axes were examined. A supplementary AI analysis explored automated detection of these findings. Ethics approval and opt‑out consent were obtained.

Both Plan A and Plan B were non‑inferior to the conventional score. Plan B demonstrated the highest discrimination and consistently improved inter‑rater reliability. Black spots showed a weak‑to‑moderate correlation with bleeding, supporting their role as a pretreatment surrogate, whereas granular changes showed no significant correlation with bleeding and contributed independent diagnostic value.

Incorporating black spots and granular changes enables reliable pretreatment assessment of chronic epipharyngitis without abrasion and may support clinical decision-making regarding consideration of epipharyngeal abrasive therapy. This non‑invasive framework improves diagnostic objectivity and reproducibility and may support pragmatic pretreatment decision-making, including consideration of epipharyngeal abrasive therapy based on endoscopic findings. Multi‑center prospective studies are warranted to confirm external validity.