Predictive Findings of Allergic Disease in Fiberoptic Nasolaryngoscopy

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.