The utility of using fiberoptic endoscopy in the diagnosis of nasal polyps

Nasal examination is important in assessing patients with rhinitis. Most allergists examine the nose using an otoscope (OT). Most do not perform fiberoptic rhinoscopy (FR). The purpose of this study is to determine the sensitivity for identifying nasal polyps (NP) with OT examination using FR findings as the gold standard.

This study was performed in a referral allergist’s practice in Ontario. In a prospective study, all patients with rhinitis symptoms had OT examination and FR. Patients who had NP identified with FR were included in the study. The findings of the OT examination were compared to the FR findings. Other data collected included allergy skin test results, presence of asthma, aspirin allergy, previous nasal surgeries, intranasal corticosteroid (INS) use and leukotriene receptor antagonist (LTRA) use.

Eighty six patients were identified to have NP with FR. Forty nine patients (57%) had NP identified by OT examination. Forty (47%) of patients with NP had positive skin tests for at least one aeroallergen. Fifty-nine (68%) had asthma, 13 (15%) had an ASA allergy and 10 (12%) had both conditions. Forty-eight (56%) were using an INS and 9 (10%) were on LTRA. Thirty-four (40%) had previous surgery.

The OT examination had a 57% sensitivity. Therefore, in this study, 43% of patients with nasal polyps would have had their nasal polyps missed if FR was not performed.