Inter- and intra-rater reliability of a nasal endoscopy index for pattern identification in patients with allergic rhinitis

In Western medicine, nasal endoscopy is a useful tool for the diagnosis of allergic rhinitis (AR) and for differentiating it from sinusitis. On the other hand, in Traditional Korean Medicine (TKM), clinicians use the technique for pattern identification, a diagnostic method unique to TKM, in patients with AR. However, no reliable studies have been conducted to establish a nasal endoscopy index that is applicable for pattern identification in patients with AR. We developed a nasal endoscopy index for pattern identification-based diagnosis in patients with AR and investigated its reliability in AR patients by evaluating inter-and intra-rater reliability for the assessment of nasal membrane color (pale or hyperemia), rhinorrhea (watery or yellow), and inferior turbinate swelling (hypertrophy). We collected the nasal endoscopic data from patients who visited the department. Six specialists in the department of Otolaryngology of Korean Medicine evaluated 20 nasal endoscopic images on two separate occasions. The intra-rater agreement for pattern identification of each parameter was generally good to excellent, ranging from 0.62 to 0.79. The inter-rater agreement was moderate to good, ranging from 0.42 to 0.68. This study provides the evidence for an objective and reproducible technique for using nasal endoscopy in pattern identification assessments of AR patients receiving treatment with TKM.