Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study
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Abstract
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.