2014年09月01日

面白い記事

 経鼻喉頭ファイバースコープ検査およびアレルギー検査を受けた患者88人を対象に、アトピーの診断における内視鏡所見の有用性を症例対照解析で検討。耳管隆起の異常(P=0.007)および鼻咽腔の分泌物増加(P=0.038)はアトピー性疾患の予測因子だった。アトピー陽性は喉頭よりも鼻咽頭内の検査所見で予測されることが示唆された。
「アレルギー(アトピー)診断、鼻咽頭内視鏡で予測」という記事ですが・・・・臨床的には一部に疑問も感じますが、面白いので、原文を以下に提示します。

文献:Brook C,et al.Predictive findings of allergic disease in fiberoptic nasolaryngoscopy.Laryngoscope. 2014 Aug 14. doi: 10.1002/lary.24880. [Epub ahead of print]

Objectives/Hypothesis
To determine whether findings on fiberoptic nasolaryngoscopy beyond the nasal cavity can aid in diagnosis of atopy.
Study Design
Case control analysis of patients undergoing fiberoptic nasolaryngoscopy and allergy testing at a single academic institution.
Methods
Patients who underwent flexible nasolaryngoscopy for either laryngeal or nasal symptoms and allergy testing by in vitro methods were divided into an atopic group and a nonatopic control group based on results of allergy testing. Three board-certified otolaryngologists who were blinded to the atopic status and symptoms viewed 88 patient videos and filled out an 8-item endoscopic rating questionnaire for each. Correlation between rater scores, endoscopic findings, and atopic status was calculated using Randolph's multirater kappa values and Mann-Whitney test.
Results
Intrarater reliability was moderate to perfect for all physicians on all questions (kappa 0.545–1.0). Inter-rater reliability was slight to fair (kappa 0.143–0.399) for all questions and the overall impression of atopic disease. Abnormalities of the torus tubarius (P = .007) and increased nasopharyngeal secretions (P = .038) were predictive of atopic disease, whereas the presence of an adenoid (P = .08) and impression of atopic disease (P = .15) approached significance. All other endoscopic measures were not predictive of atopic status.
Conclusions
Fiberoptic nasolaryngeal findings within the nasopharynx rather than the larynx are predictive of a positive atopic status.
Level of Evidence
3b. Laryngoscope, 2014

【 名古屋市名東区 | 松永クリニック | 耳鼻咽喉科 | 皮膚科 | アレルギー科 | 】
posted by 院長 at 00:10| 医療情報「のど」