Maxillary sinuses plain film radiographs of 59 patients were reviewed and reported by both clinicians or Radiologists at the University Hospital, Kuala Lumpur. There was agreement in 52 reports of the plain film radiographs however there was partial differences in about seven cases. This gave an impression that the ENT specialist and the Radiologist were both capable of reporting plain film radiographs of maxillary sinuses, even though the radiologist has no opportunity of doing detail clinical examination of the patient.

Comparative study of plain-film radiographs of maxillary sinuses between radiologists and clinicians.

5 abstract The number of diagnosed acute otitis media (AOM) and acute maxillary sinusitis (AMS) cases is increasing for no apparent reason. Most diagnoses are made in primary health care, and despite the frequency of these diseases, some diagnoses may be inaccurate. Primary health care has no methods even to evaluate nasal function, whereas new methods at university clinics produce information of unknown clinical relevance. We conducted fi ve prospective studies: We compared diagnostic equipment, diagnostic criteria, and diagnoses of general practitioners and the otorhinolaryngologist for 50 children with parent-suspected AOM and for 50 adults with self-suspected AMS (III, I). To learn whether the use of strict diagnostic criteria has any infl uence on incidence of AOM in otitis-prone children, we conducted a 6-month follow-up study in almost 300 children (IV). We tested the properties of two new nasal functioning tests, peak nasal expiratory fl ow (PNEF) and inspiratory fl ow, (PNIF) in 100 healthy adults (II). We compared magnetic resonance imaging fi ndings (MRI) in the middle ear and mastoid cavity and AOM history in 50 children scanned for neurological purposes (V). Our results indicate that AOM and AMS diagnoses in primary care are frequently based merely on symptoms and nonspecifi c clinical fi ndings. Diagnostic criteria are loose, and diagnostic equipment seldom used. Use of strict diagnostic criteria and of the pneumatic otoscope and tympanometry reduces AOM diagnoses signifi cantly (III, I). PNIF and PNEF measurements are highly variable and poorly repeatable and thus unsuitable as diagnostic methods (II). Incidental high signal intensity mimicking acute infection may occur in scans of the middle ear and mastoid cavity in children with healthy ears (V). Accurate diagnosis of upper respiratory infections has an impact on both the individual patient and the whole of society. Accurate diagnoses could reduce the number of operations such as tympanostomies, adenotomies, and sinonasal surgery, and thus cut health care costs; limited use of antibiotics could delay the development of antimicrobial-resistant bacteria. When limitations in diagnostics are recognized, it is possible to develop new diagnostic equipment and ensure that medical education for students and primary practitioners is focused wisely. Blomgren_K 5 21.11.2003, 11:03:59 introduction 7 introduction Acute otitis media (AOM) is the most common, and acute maxillary sinusitis (AMS) is the fi fth most common indication for antimicrobial treatment, with incidences of both AOM and AMS increasing rapidly (McCaig and Hughes 1995; Joki-Erkkila et al. 1998; Schappert 1999). Both infections have a substantial impact on the economy of families, of employees, and of health care systems (Kaliner et al. 1997; Niemela et al. 1999). AOM alters children’s hearing at a critical age, which may have longlasting consequences throughout childhood (Margolis and Hunter 1991). Children with multiple AOM episodes before the age of three may have weaker linguistic skills and poorer classroom concentration and mathematics skills at school than do children with few episodes (Teele et al. 1990; Luotonen et al. 1996; Luotonen et al. 1998). Despite the huge impact of upper respiratory infections, criteria for diagnoses are often loose, and physicians are often uncertain of their diagnoses (Froom et al. 1990; van Duijn et al. 1992; Hansen et al. 1995; Makela and Leinonen 1996; Lyon et al. 1998). Unwarranted use of antibiotics prescribed for viral infections leads to the worldwide problem of antimicrobial resistance (Neu 1992; Manninen et al. 1997). The reliability of the diagnosis of bacterial infections is frequently questionable (Gonzales 1997; Palmer and Bauchner 1997; Nyquist et al. 1998). Accurate diagnosis is equally essential to avoid the overdiagnosing which results in unnecessary medication and surgery, and the underdiagnosing which causes delays in therapy (Pelton 1998). Acute mastoiditis still exists, and AOM may be overlooked without pneumatic otoscopy (Schwartz et al. 1981b; Ghaffar et al. 2001). At the moment, no truly effective and practical method exists for prevention of either viral upper respiratory infections (URI) or their bacterial complications. Roughly one-fi fth of URI cases in children are complicated by AOM, resulting annually in 500 000 episodes of AOM in Finland, alone (Heikkinen et al. 1995; Niemela et al. 1999). Adults have from two to three common colds annually, and 0.5% to 2% of these end in AMS (Dingle et al. 1964; Berg et al. 1986; Gwaltney 1997). The clinician must fi nd parameters and diagnostic tools to distinguish bacterial infections from other infl ammatory disorders. Radiologic studies of the upper respiratory area performed for reasons not related to ear, nose, and throat diseases also produce information of unknown clinical relevance (Cooke and Hadley 1991; Patel et al. 1996). As long as infections cannot be prevented, diagnoses must be as accurate as possible. The belief that patients with upper respiratory infections are satisfi ed only when they receive a prescription for antibiotics may actually be a myth. Patients are satisfi ed with their diagnosis and treatment when they understand their illness and feel that the examination was thorough (Hamm 1996). When the diagnosis is based on a careful examination, it is also more likely that it is correct. Blomgren_K 7 21.11.2003, 11:04:00 review of the literature 9 review of the literature

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Diagnosis of acute maxillary sinusitis and acute otitis media

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Diagnosis of acute maxillary sinusitis and acute otitis media