Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework

Layla M Babahaji; Vinayak Ganeshan; Thinh S Nguyen; Omar Ahmed; Blair M Barton; Rakesh Chandra; Philip G Chen; David A Gudis; Akaber Halawi; Thomas S Higgins; Stephanie A Joe; Edward C Kuan; Michael J Marino; Zara M Patel; Vijay R Ramakrishnan; Sanjeet V Rangarajan; Charles A Riley; Christopher R Roxbury; Abtin Tabaee; Dennis M Tang; Arthur W Wu; Michael T Yim; Jonathan Bidwell; Edward D McCoul

doi:10.1002/ohn.889

Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework

Otolaryngol Head Neck Surg. 2024 Oct;171(4):1052-1061. doi: 10.1002/ohn.889. Epub 2024 Jul 5.

Authors

Layla M Babahaji¹, Vinayak Ganeshan¹, Thinh S Nguyen¹, Omar Ahmed², Blair M Barton¹, Rakesh Chandra³, Philip G Chen⁴, David A Gudis⁵, Akaber Halawi⁶, Thomas S Higgins⁷, Stephanie A Joe⁸, Edward C Kuan⁹, Michael J Marino¹⁰, Zara M Patel¹¹, Vijay R Ramakrishnan¹², Sanjeet V Rangarajan¹³, Charles A Riley¹⁴, Christopher R Roxbury¹⁵, Abtin Tabaee¹⁶, Dennis M Tang¹⁷, Arthur W Wu¹⁷, Michael T Yim¹⁸, Jonathan Bidwell¹, Edward D McCoul^{1

19}

Affiliations

¹ Department of Otorhinolaryngology, Ochsner Health, New Orleans, Louisiana, USA.
² Department of Otolaryngology-Head and Neck Surgery, Houston Methodist, Houston, Texas, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Texas-Health Science Center San Antonio, San Antonio, Texas, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA.
⁶ Union Memorial Hospital, Baltimore, Maryland, USA.
⁷ Kentuckiana ENT, Louisville, Kentucky, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Illinois-Chicago, Chicago, Illinois, USA.
⁹ Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California-Irvine, Orange, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁴ Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁵ Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, USA.
¹⁶ Department of Otlaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA.
¹⁷ Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana, USA.
¹⁹ Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA.

PMID: 38967295
DOI: 10.1002/ohn.889

Abstract

Objective: Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies.

Study design: A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations.

Setting: An online questionnaire was distributed in July 2023.

Methods: The questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W-NASs) to represent the perceived importance of each feature, scaled from 0 to 1.

Results: General concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W-NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W-NAS, 0.67). Similar analyses were performed for features in each case.

Conclusion: The implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision-making during nasal endoscopy.

Keywords: epistaxis; machine learning; nasal congestion; nasal endoscopy; nasal polyps; postnasal drip; sinusitis.

MeSH terms

Endoscopy*
Humans
Nose Diseases / diagnosis
Surveys and Questionnaires
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