Browsing by Author "Ciger, E"

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    Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings
    Eren, E; Arslanoglu, S; Aktas, A; Kopar, A; Ciger, E; Önal, K; Katilmis, H
    The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS > 7 or RSI > 13 was considered reflux positive. Fleiss' kappa (kappa) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (kappa = 0.078), ventricular obliteration (kappa = 0.206), diffuse laryngeal edema (kappa = 0.204), and posterior laryngeal hypertrophy (kappa = 0.27), intermediate for laryngeal erythema/hyperemia (kappa = 0.42) and vocal fold edema (kappa = 0.42), and high for thick endolaryngeal mucus (kappa = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.
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    Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study
    Eren, E; Aktas, A; Arslanoglu, S; Kopar, A; Ciger, E; Özkul, Y; Önal, K; Katilmis, H
    ObjectiveTo determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. DesignProspective observational study. SettingUniversity Teaching hospital. ParticipantsOne hundred and eight patients were referred from the allergy clinic included in the study. Main outcome measuresPredictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. ResultsLogistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (=0,48, P<0.001), polypoid degeneration of the inferior turbinate tail (=0.48, P=0.01), nasal polyps (=0.96, P<0.001) and nasal septal deviation (=0.65, P=0.01) showed significant inter-rater agreement. A low coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P=0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (=0.31) and turbinate colour (=0.38) showed no significant inter-rater agreement. ConclusionsPatient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study.
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