Evaluation of nasal septal deviation in patients with chronic rhinosinusitis – an interrater agreement study

Abstract

Background: The significance of nasal septal deviations may be hard to evaluate. Patient history, clinical examination, nasal endoscopy and sinus CT scans contribute in the evaluation. We aimed to investigate the interrater agreement in the evaluation of nasal septal deviations in patients with chronic rhinosinusitis (CRS). Methodology: A total of 30 patients were included in the study. Three rhinologists using nasal endoscopy evaluated the presence and degree of septal deviation. A rhinologist and a radiologist also evaluated the presence and degree of septal deviation on sinus CT scans. Interrater agreement was measured using unweighted Fleiss’ kappa (Kf). Results: In the endoscopic evaluation of septal deviation, the raters attained a Kf of 0.31 (SE 0.12), 0.33 (SE 0.11) and 0.37 (SE 0.11) for the assessment of anterior deviations, inferior/posterior deviations and deviations by the perpendicular plate, respectively. In the radiologic evaluation of septal deviation, the raters attained a Kf of 0.52 (SE 0.13), 0.63 (SE 0.16) and 0.38 (SE 0.16) for the assessment of anterior deviations, inferior/posterior deviations and deviations by the perpendicular plate, respectively. Conclusion: Our study showed a limited agreement in the endoscopic evaluation of septal deviation. Conversely, a higher agreement was achieved in the radiologic evaluation. Sinus CT scans might be a helpful objective examination technique, but it cannot be an alternative to clinical evaluation using acoustic rhinometry, rhinomanometry or Peak Nasal Inspiratory flow.

Keywords

• nasal septum
• nasal obstruction
• nasal surgical procedures
• observer variation
• endoscopy