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Wise et al.

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Policy Level: Recommendation.

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• Intervention: History taking is essential in the diagnosis of AR. Physical examination is recommended in the diagnosis of AR, and when combined with patient history, it increases diagnostic accuracy and excludes alternative causes.

VIII.B. Nasal endoscopy

Diagnostic nasal endoscopy is an option for the evaluation of patients with suspected AR. Several uncontrolled observational studies evaluated the association of endoscopic findings with symptomatic rhinitis, with inconsistent results (Table VIII.B). Ameli et al. 782 evaluated children with suspected AR, reporting that endoscopic findings of inferior or middle turbinate septal contact was predictive for AR, while pale turbinates were not. Conversely, Eren et al. 783 evaluated a population of adult patients with rhinitis, concluding that findings of nasal endoscopy do not provide a reliable diagnosis of AR. Among adults and children with AR that is confirmed by allergy testing, no significant correlation was found between nasal endoscopy and specific nasal symptoms. 784 Central compartment atopic disease (CCAD) represents the recently described association between atopic states and centrally-located inflammation involving the middle/superior turbinates or superior nasal septum. 785-787 In a recently published parallel case series (LOE = 4), Brunner et al. 788 evaluated patients with CRSwNP vs isolated polypoid change of the middle turbinate. Significant findings include a higher prevalence of AR in patients with middle turbinate polypoid change (83% vs 34%, p < 0.001), further supporting CCAD as a unique atopic condition. Although the association of endoscopic findings with AR has been shown to be inconsistent, nasal endoscopy may aid in the identification or exclusion of other possible causes of symptoms, such as nasal polyposis or CRS. • Aggregate Grade of Evidence: D (Level 3b: 2 studies; Level 4: 3 studies; Table VIII.B).* • Benefit: Possible improved diagnosis with visualization of turbinate contact or isolated central compartment edema. • Harm: Possible patient discomfort. • Cost: Moderate equipment and processing costs, as well as procedural charges. • Benefits-Harm Assessment: Equal. • Value Judgments: None. • Policy Level: Option. • Intervention: Nasal endoscopy may increase diagnostic sensitivity among children and adults with AR and may aid in ruling out other causes for nasal symptoms. *Due to recent publication and in accordance with ICAR methodology, DelGaudio et al. 787 and Brunner et al. 788 are excluded from the Aggregate Grade of Evidence.

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.