Office-Based Digital Video Endoscopy in Otolaryngology

Endoscope Image Capture System with Mirrorless Camera

Modern endoscopic surgery relies on capturing high fidelity images for a multitude of purposes. One method of capturing images involves incorporating infrared and 4 k resolution video in the image capture system. However, the price of such whole image capture systems remains expensive and potentially cost prohibitive for some practitioners. A major need exists for less expensive alternatives. Herein, we introduce a method of using a mirrorless camera for the purposes of an endoscope capture device. This system comprises components that are all readily commercially available. Sample pictures taken by this system are provided and the potential function of mirrorless camera is explored. This image capture system provides reasonable quality images, should be more reasonably affordable and easily implementable in variety of practices, and will help decrease the barriers to producing research in the area of endoscopic surgery.

Interrater agreement of nasal endoscopy in patients with a prior history of endoscopic sinus surgery

BACKGROUND

Nasal endoscopy is an important part of the clinical evaluation of patients with chronic rhinosinusitis. However, the objectivity and interrater agreement of the procedure related findings have not been well studied, especially in patients who have previously had sinus surgery.

METHODS

Patients with a history of endoscopic sinus surgery for chronic rhinosinusitis were prospectively enrolled from a tertiary rhinology practice. Fourteen endoscopic nasal examinations were recorded using digital video capture software. Each patient also underwent computed tomography (CT) and completed the Sinonasal Outcome Test (SNOT-22). Blinded review of inflammatory and anatomic findings for each video was independently performed by 5 academic rhinologists at separate institutions. Comparisons were performed using the unweighted Fleiss' kappa statistic (K(f) ) and the prevalence- and bias-adjusted kappa (PABAK).

RESULTS

There were no significant correlations between age, Lund-Mackay score, or SNOT-22 score. Interrater agreement was variable across the characteristics studied. Mean PABAK was excellent for the assessment of polyps (K(f) = 0.886); moderate for the assessments of middle turbinate (MT) integrity (K(f) = 0.543), MT position (K(f) = 0.443), maxillary sinus patency (K(f) = 0.593), and ethmoid sinus patency (K(f) = 0.429); fair for discharge (K(f) = 0.314), synechiae (K(f) = 0.257), and middle meatus patency (K(f) = 0.229); and poor for MT mucosal changes (K(f) = 0.148) and uncinate process (K(f) = 0.126).

CONCLUSION

This study was notable for variability in the interrater agreement among the inflammatory and anatomic attributes that were examined. Further standardization of nasal endoscopy with regard to interpretation may improve the reliability of this procedure in clinical practice.

Interrater agreement of nasal endoscopy for chronic rhinosinusitis

BACKGROUND

Nasal endoscopy is a routine, important diagnostic tool in the evaluation of chronic rhinosinusitis (CRS). Although the procedure is ideally "objective," the subjective nature of endoscopy interpretation and lack of standardization are potential limitations. The goal of this study was to examine the interrater agreement of various categories of nasal endoscopy findings in patients undergoing evaluation for CRS.

METHODS

Fourteen patients (28 sides) with CRS underwent clinical evaluation, SNOT-22, sinus computed tomography (CT), and digital video nasal endoscopy. Five academic rhinologists blindly reviewed the endoscopies for structural anatomic issues, inflammatory rhinosinusitis findings, and atypical lesions. Statistical comparison of the endoscopy interpretations was performed using the unweighted Fleiss' kappa statistic (K(f) ).

RESULTS

The mean Lund-Mackay CT scan score was 7.8 (standard deviation [SD] 4.9) and the mean SNOT-22 score was 35.8 (SD 22.7). Significant variability was noted among the raters with respect to the various categories of nasal endoscopy findings. The overall levels of interrater agreement for the various categories were as follows: "almost perfect" for atypical lesions (K(f) = 0.912); "substantial" for nasal polyps (K(f) = 0.693); "moderate" for nasal discharge (K(f) = 0.422) and mucosal inflammatory changes of the middle turbinate (K(f) = 0.413); and "fair" for edema of the middle meatus (K(f) = 0.214), obstruction by nasal septum deviation (K(f) = 0.240), and obstruction by the middle turbinate (K(f) = 0.276).

CONCLUSION

Significant variability was noted in the interrater agreement for nasal endoscopy findings in this study, with relatively limited agreement on some of the key findings of the procedure. Additional investigation and standardization of nasal endoscopy interpretation is required to improve the clinical utility of the procedure.

A low-cost, endoscopic, digital, still and video photography system for ENT clinics

Image capture systems that display and record endoscopic images are important for documentation and teaching. We have modified a universal serial bus microscope to couple with most clinical endoscopes used in our practice. This very economical device produces images suitable for teaching, and potentially for clinical use. The implications of this could be significant for teaching, patient education, documentation and the developing world.

Low cost digital endoscopic photography

Introduction:

Endoscopic digital photography usually involves expensive and often cumbersome equipment.

Aim:

This study aimed to construct a low cost adaptor with which to connect a budget-priced digital camera to a nasal endoscope, in order to enable inexpensive, good quality otology photography.

Method:

A method of making an adaptor from a simple plastic bottle top is described, and the photographic technique is outlined.

Results:

The adaptor fitted well with commonly used endoscopes, and excellent results were obtained.

Conclusion:

High quality digital endoscopic photographs can be obtained using a low cost compact digital camera fitted with a simple adaptor made from a plastic bottle top. Such a method would make digital photography via a rigid endoscope easily affordable worldwide.