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1 Department of Otorhinolaryngology–Head and Neck Surgery, School of Medicine, Razi Specialized Hospital, Birjand University of Medical Sciences, Birjand, Iran
Abstract: (16 Views)
Background and Objective: Establishing more accurate clinical diagnostic criteria is essential to improve both bedside diagnosis and the appropriate selection of patients for computed tomography (CT) imaging. This study aimed to evaluate the diagnostic value of clinical symptoms in chronic sinusitis and to assess their concordance with CT scan findings (Lund-Mackay score) in patients undergoing functional endoscopic sinus surgery (FESS).
Methods: A cross-sectional study was conducted on 206 patients referred for paranasal sinus CT scans due to suspected chronic sinusitis and subsequently underwent surgery after diagnosis. Clinical symptoms, including nasal congestion, postnasal drip, facial pain, headache, and sleep disturbances, were recorded. CT scans were analyzed using the Lund-Mackay scoring system. Diagnostic accuracy indices were calculated to evaluate the ability of clinical symptoms to predict CT scan findings. Sensitivity and specificity were determined for each clinical symptom using CT findings as the reference standard. In addition, the positive predictive value and negative predictive value were calculated to assess the probability of disease presence or absence given the clinical symptoms. Positive and negative likelihood ratios were also computed to further evaluate the diagnostic performance of clinical symptoms.
Results: The chi-square test showed that the CT scan findings had a significant association with the patients' smoking status (P = 0.01). The CT scan results based on patients' postnasal drip status are presented. The chi-square test showed that the CT scan findings had a significant association with postnasal drip in patients (P = 0.004). The sensitivity and specificity values of the evaluated symptoms were as follows: nasal discharge showed a sensitivity of 53.2% and a specificity of 58.9%. Post pharyngeal drip had a sensitivity of 37.8% and a specificity of 42.1%. Nasal congestion demonstrated a sensitivity of 66.67% and a specificity of 29.47%. The sensitivity and specificity for the history of headaches were 47.75% and 53.68%, respectively. Sleep disturbances showed a sensitivity of 47.7% and a specificity of 62.1%.
Conclusion: While certain clinical symptoms, such as postnasal drip, show a significant concordance with CT scan findings in patients undergoing FESS, other symptoms appear to have limited diagnostic value in predicting the severity of radiological sinusitis. Therefore, relying solely on clinical symptoms is insufficient, and CT imaging remains essential for accurate preoperative evaluation and surgical planning.
Key words: Chronic sinusitis, Clinical diagnosis, CT scan, Sensitivity, Specificity
Methods: A cross-sectional study was conducted on 206 patients referred for paranasal sinus CT scans due to suspected chronic sinusitis and subsequently underwent surgery after diagnosis. Clinical symptoms, including nasal congestion, postnasal drip, facial pain, headache, and sleep disturbances, were recorded. CT scans were analyzed using the Lund-Mackay scoring system. Diagnostic accuracy indices were calculated to evaluate the ability of clinical symptoms to predict CT scan findings. Sensitivity and specificity were determined for each clinical symptom using CT findings as the reference standard. In addition, the positive predictive value and negative predictive value were calculated to assess the probability of disease presence or absence given the clinical symptoms. Positive and negative likelihood ratios were also computed to further evaluate the diagnostic performance of clinical symptoms.
Results: The chi-square test showed that the CT scan findings had a significant association with the patients' smoking status (P = 0.01). The CT scan results based on patients' postnasal drip status are presented. The chi-square test showed that the CT scan findings had a significant association with postnasal drip in patients (P = 0.004). The sensitivity and specificity values of the evaluated symptoms were as follows: nasal discharge showed a sensitivity of 53.2% and a specificity of 58.9%. Post pharyngeal drip had a sensitivity of 37.8% and a specificity of 42.1%. Nasal congestion demonstrated a sensitivity of 66.67% and a specificity of 29.47%. The sensitivity and specificity for the history of headaches were 47.75% and 53.68%, respectively. Sleep disturbances showed a sensitivity of 47.7% and a specificity of 62.1%.
Conclusion: While certain clinical symptoms, such as postnasal drip, show a significant concordance with CT scan findings in patients undergoing FESS, other symptoms appear to have limited diagnostic value in predicting the severity of radiological sinusitis. Therefore, relying solely on clinical symptoms is insufficient, and CT imaging remains essential for accurate preoperative evaluation and surgical planning.
Key words: Chronic sinusitis, Clinical diagnosis, CT scan, Sensitivity, Specificity
Type of Study: Research |
Subject:
Otolaryngology_ENT
Received: 2025/09/8 | Accepted: 2026/04/28 | ePublished ahead of print: 2026/07/11
Received: 2025/09/8 | Accepted: 2026/04/28 | ePublished ahead of print: 2026/07/11
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