台灣人的慢性鼻及鼻竇炎症狀表現與國際診斷標準之相關性研究

Correlation of the Symptoms Presentation of Taiwanese CRS Patients with AAOHNS CRS Diagnostic Criteria

黃家昌(Chia-Chang Huang) ； 戴志展(Chih-Jaan Tai) ； 鄒永恩(Yung-An Tsou) ； 蔡銘修(Ming-Hsui Tsai)

《台灣耳鼻喉頭頸外科雜誌》 46卷6期 (2011/12) Pp. 283-288

https://doi.org/10.6286/2011.46.6.283

摘要

背景：鼻竇炎之診斷目前國際上普遍遵循以美國耳鼻喉暨頭頸外科醫學會（AAOHNS）於1997年所制訂以症狀為主的診斷標準，且將慢性鼻及鼻竇炎定義為超過12週之疾病。本研究在探討台灣慢性鼻及鼻竇炎患者之臨床症狀與AAOHNS慢性鼻及鼻竇炎診斷標準之相關性。方法：本研究採前瞻性設計，收集符合1997年AAOHNS所訂定之慢性鼻及鼻竇炎診斷標準之患者共自81名，由病患以視覺類比量表記錄其症狀嚴重度，同時由醫師記錄鼻腔檢查與電腦斷層掃瞄檢查發現。我們以權重計分的方式，將主要症狀分數（major symptom score）乘以1，次要症狀分數（minor symptom score）乘以0.5，經量化後進行相關性統計分析。結果：一、台灣慢性鼻及鼻竇炎患者常見的症狀表現與AAOHNS所制訂之診斷標準不盡相同，主要標準的症狀表現以膿鼻涕／倒流、鼻塞與嗅覺退化較為常見，次要標準之症狀表現以疲倦與咳嗽較為常見；二、病患術後疼痛一般為短暫且不嚴重；三、理學檢查發現有重要診斷價值；四、影像學發現與部分症狀的嚴重度具相關性。結論：慢性鼻及鼻竇炎之診斷需要多面向的評估，以症狀結合理學檢查發現做出診斷，雖然在準確度上有所缺憾，但兼顧了醫療的可近性與經濟效益。以國際通用之AAOHNS的診斷標準來診斷台灣的慢性鼻及鼻竇炎可能會有落差，國內應建立本土之診斷標準，並據此作為評估病程及療效之依據。（台耳醫誌 2011；46：283－288）

關鍵字

慢性鼻及鼻竇炎 ； 診斷 ； 台灣人的

並列摘要

BACKGROUND: Symptoms of chronic rhinosinusitis (CRS) are variable and nonspecific, which made disease diagnosis and outcomes evaluation difficult Diagnostic criteria approved by the Taskforce of the American Academy of Otolaryngology-Head and Neck Surgely (AAOHNS) in 1997 are applied universally. The criteria also defines CRS as symptoms persisting more than 12 weeks. Owing to different ethnic, Taiwanese CRS patients' symptoms are probably not as same as those of Caucasian-major population have. This study wishes to investigate the correlation of the symptoms presented in Taiwanese CRS patients with AAOHNS CRS diagnostic criteria.METHOD: In this prospective study, 81 CRS patients conform to clinical diagnostic criteria of CRS proposed by AAOHNS in 1997 are included. Patients recorded their severity of clinical symptoms with Visual Analog Scale (VAS). Meanwhile, Otolaryngologist evaluated the findings of physical examination and the severity of sinus CT scan. Dataset are quantified and then proceeded statistics analysis.RESULT: Common symptoms of Taiwanese CRS patients partially differ from AAOHNS diagnostic criteria. Major symptoms of Taiwanese CRS patients include purulent/discolored postnasal drainage, nasal obstruction/blockage and hyposmia/anosmia. Fatigue and cough are the most minor symptoms. Physical examination plays a key role in clinical diagnosis. Correlations between image findings and certain symptoms severity are noted.CONCLUSION: Diagnosis of CRS entails multiple directional evaluations. Diagnostic method based on symptoms along with physical examination proves valuable yet gets limited specificity while supplying better medical accessibility and economic benefits. Diagnosis of CRS in Taiwanese patients by using AAOHNS CRS diagnostic criteria is not suited potentially. A domestic diagnostic criteria is helpful to evaluate outcomes of treatment for our patients. (J Taiwan Otolaryngol Head Neck Surg 2011; 46:283-288)

並列關鍵字

chronic rhinosinusitis ； diagnosis ； Taiwanese