Utility of narrow band imaging in the diagnosis of middle turbinate head edema

Eugene Wong; Aneeza W Hamizan; Raquel Alvarado; Carolyn A Orgain; Larry Kalish; Raymond Sacks; Richard J Harvey

doi:10.1016/j.amjoto.2018.06.019

Utility of narrow band imaging in the diagnosis of middle turbinate head edema

Am J Otolaryngol. 2018 Sep-Oct;39(5):570-574. doi: 10.1016/j.amjoto.2018.06.019. Epub 2018 Jun 22.

Authors

Eugene Wong¹, Aneeza W Hamizan², Raquel Alvarado³, Carolyn A Orgain³, Larry Kalish³, Raymond Sacks³, Richard J Harvey⁴

Affiliations

¹ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia. Electronic address: eugene.hl.wong@gmail.com.
² Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Department of Otorhinolaryngology-Head & Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
³ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.
⁴ Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

PMID: 29961655
DOI: 10.1016/j.amjoto.2018.06.019

Abstract

Purpose: Middle turbinate head edema has recently been found to have high specificity for diagnosis of inhalant allergy. However, subtle mucosal edema can be difficult to appreciate under white light endoscopy. Narrow band imaging (NBI) has the potential to demonstrate edema by identifying reduced mucosal vascularity and improve sensitivity for the detection of mucosal edema. Narrow band imaging was assessed to determine its utility in objectifying mucosal edema.

Meaterials and methods: A cross-sectional diagnostic study was performed on patients with edematous mucosa of the middle turbinate head. Under traditional white light endoscopy, areas of edematous mucosa were identified. Using NBI, these areas were compared to areas of normal mucosa on the middle turbinate head. NBI images of these same areas were then converted to grey scale and a vascularity index was created by pixel analysis and brightness in Fiji Image J software (Wisconsin, US).

Results: Thirty-three middle turbinates were assessed (age 42.4 ± 12.5, 42.4% female). NBI discriminated between areas identified under white light endoscopy as edematous and normal (158.2 ± 48.4 v 96.9 ± 32.7 p < 0.01). Receiver operating curve (ROC) analysis suggested a threshold of 115 brightness units to define endoscopically visible edematous mucosa with sensitivity 70% and specificity 79% (ROC AUC, p = 0.85).

Conclusions: NBI can differentiate edematous from normal mucosa. The potential for an objective measure of mucosal edema may assist research efforts and may provide a more sensitive tool for subtle mucosal inflammatory changes.

Keywords: Band; Edema; Endoscopy; Head; Imaging; Middle; Narrow; Rhinitis; Turbinate.

MeSH terms

Adult
Cross-Sectional Studies
Edema / diagnostic imaging*
Endoscopy*
Female
Humans
Male
Middle Aged
Narrow Band Imaging*
Nasal Mucosa / diagnostic imaging*
Proof of Concept Study
Rhinitis, Allergic / diagnostic imaging*
Sensitivity and Specificity
Turbinates / diagnostic imaging*